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Full text of "The Medical summary. A monthly journal of practical medicine, new preparations"

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INDEX TO VOLUME XXXIV 
OF 

THE MEDICAL SUMMARY 

March, 1912, to February, 1913 



R. H. Andrews, M.D. 



Philadelphia, Pa. 



Editor and Publisher 



A Study of the Materia Medica and The- 
rapeutics 12 

Appendicitis 20, 175,201 

Alterative 20 

An Unusual Case 23 

A Wonderful Remedy 2^\ 

Atropine 26, 198, 356 

Alcoholism 28 

Abscess and Fistula of the Rectal Region. 37 

An Agreeable Disinfectant 52 

Antiperiodic 53 

An Anodyne Liniment 53 

A Penetrating Liniment 53 

An Interrogatory Paper 55 

Accute Indigestion and Some Interest- 
ing Facts 56, 244 

Abused Stomachs 57 

A New Kind of Hospital.. 67 

A Great Healer 83 

An Analgesic 85 

A Means of Emptying the Bladder 85 

Adenoids 86 

A Peculiar Skin Trouble 91 

Apomorphine Hypodermically Applied... 94 

A Local Application for Pain 97 

Abraham Jacobi 100 

A Doctor's Story 119 

Attention to Details 132 

Angina Pectoris 136 

Asthma 150, 158, 219, 258, 281 

An Every- Day Philosopner 170 

A Few Reflections 173 

Aconite and Its Uses 183, 254 

Antiseptic Nasal Ointment 183 

Abortion 184 

Amputation 200 

A Nasal Wash 213 

Acne 217, 248 

Ancient Arterial Disease 218 

A Contribution to the Study of Hernias of 
the Ovary, Tube, and Tube and 

A 9^^\y ""^ ^3^» 2^» ^3 

A Check on Degeneracy 226 

About Trees 225 

August Summary 242 

Arteriosclerosis 245 

A Good Pill 245 

A Peculiar Case 252 

An Unequal Struggle 306 

Agarisn '310 

Apoplectic Seizure 310 



A Little Physiology 315 

A Useful Tablet 317 

Alexis Carrel 232 

Absolute Necessity 283 

Antit3rphus Serum Therapy 237 

A Valuable Substitute 258 

Are the Offsprings of Drunkards Defect- 
ive? 355 

Angioneurotic Edema 362 

Arteriosclerosis 377 

Bronchitis 66 

Babies in Style 66 

Bleeding of the Niose 86 

Burns 86, 254 

Bichloride of Mercury 131 

Bedbugs 144, 216 

Bladder Catheterization 162 

Business Tips 193 

Baunscheidtism 206 

Bacilli 222 

Boil It Down 228 

Baptisin and Hamamelin 231 

Business Side of Medicine 251, 279 

Biblical Trust 279 

Breaking Up a Cold 292 

Blood-Letting in Pneumonia 353 

Blackheads 381 



Care of the Scalp 3 

Qinical vs. Laboratory Reports 118 

Cases in Illustration of the Efficacy of 

Blisters 369 

Correction 3» 262 

Constriction, Obstruction and Relaxation 

Important in Disease and Cure 17 

Cigarettes in Indiana 24 

Circumcision 25 

Cerebro-Spinal Meningitis 46, 121 

Croup 51 

Capsicum 58, 354 

Calomel in Intestinal Troubles of In- 
fants 77 

Cold in the Head 99 

Chancroid 102 



O 



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INDEX TO VOLUME XXXIV 



Consumption 153 

Cancer 153, 223 

Chronic Cough 183 

Creosote Medication 190 

Conjunctivitis 194, 259 

Cutaneous Horns 19S 

Cystitis 223 

Chronic Gastritis 223 

Chloroform in O'bstetrics 226 

Croton Oil 228 

Can Deafness Be Cured? 247 

Chronic Rhinitis 255 

Carcinoma of the Stomach 278 

Coffee and the Nervous System 284 

Coal Tar Preparations, Etc 285 

Chronic Constipation 291 

Chrochetingf as a Therapeutic Agent 292 

Chronic Ulcers 308 

Cure a Cold Quickly 309 

Carbuncles 312 

Can the Infant Digest Starch? 231 

Catarrhal Dyspepsia 283 

Clean Suibstances to Be Used as Medicine. 257 

Cure for Ague 259 

Causes Stricture 259 

Coughs 377 

Colds 377 

Doctor's Story 2 

Diagnosis 10, 33i 36 

Dividing the Fee 22 

Dispensing Again 33 

Dangerous Age in Women 34 

Dispensing Dangerous Drugs 35 

Diagnostic Points 61 

Disease and Old Age 75 

Dermatitis 87 

Dandruff 98 

Doctor's Own Health 98 

Dr. Henri Bogart 100 

Dr. Wiley 100 

Dysentery and Summer Diarrhea 166 

Dangers From Menthol 260 

Dipsomania 300 

Definite Medication 306 

Does Walking Reduce Flesh 356 

Do We Commence at the Right End?... 376 
Discrimination 379 

Eugenics 36, 130 

Early Menapausc 59 

Electricity as a Therapeutic Agent, 

69, loi, 134, 165, 240, 263, 304, 2^ 

Ethics 08 

Electro-Therapeutic Awakening 117 

Echinacea I49, 250 

Enema in Gastroenteric Diseases 150 

Epidemic Meningitis 

Eye Remedies 163 

Early Rising 259 

Early Theories 363 

Electricity as a Therapeutic Agent 366 

^rache 373 



Flatulence 68, 85 

Fly 82, 282 

Falling Hair 98 

For Health ; 104 

Faintness 253 

For Painful and Rheumatic Joints 278 

Fibrolysin 285 

Fistula in Ano 291 

Furunculosis 312 



Grip ;.. 4 

Gonorrhea 20, 158, 248, 282, 252 

Gleanings . .32, 64, 96, 128, 160, 192, 224, 256 

288, 230, 262 

Ginivitis in Diseases of Metabolism 86 

Gelsemium in Paralysis Agitans 118 

Gallstone Colic 149 

Give Us More of the Practical 179 

Goiter 181 

Gastric Catarrh 184 

Gastric Disorders 214 

Gastric Ulcer 223 

Gynecological Hints 260, 373 

Gleanings 384 



Health Fads 14, 87, 121 

Hemorrhoids 52, 117, 245 

Horwitz's Excellent Embrocation 53 

Hysteria 78 

Hypodermic 98 

Heart 112, 311 

Home Accessories in Obstetric Practice.. 116 

Heat Prostration 129 

Heredity a Potent Factor in Pathologic 

Conditions I43 

How Much to Tell the Patient 194 

Headache 196, 310 

How to Avoid Taking Cold 213 

Hay Fever 214, 281 

Honor to Whom Honor is Due 222 

How to Keen Hypodermic Needles in 

Good Condition 

Hyperacidity 277 

Hemoptysis in Tuberculosis 310 

Hemorrhoids 373 

Hives 181 



Intravenous Medication 7 

Intestinal Sepsis in Ocular Affections. 35 

Instrumental Delivery 58 

Iris Versicolor 06 

Is Our Educational System Wrong? 99 

Iodine as a Therapeutic Agent 109 

Ichthyol Internally ii3 

Iodine as an Antiseptic Agent 162 

In Response to Inquiries 185 

Intestinal Troubles and Infants 215 

Indigestion and Exploratory Incision 299 

Iodine in Small-Pox 30o 

Influenza 253 

Impacted Colon 372 

Itch 381 



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INDEX TO VOLUME XXXIV 



m 



Just One Example 4 

Juvenile Court 129 

July Summary 212 

Lock Jaw 29 

Literary Notes 31, 63 

Liniments 158 

Local Use of Calendula 309 

Laryngitis 310 

Lobelia Hypoderifiically 255 

Looking Back 256 



Modern Trend of Psychiatry 21 

Mustard Plaster 21 

Malaria 22, 250 

Morphinism 28, 45, 275 

Maximum Dosage of Well-Known Drugs4 40 

Mental and Drug Application 49 

May Musings 65 

Mastitis 89 

Medical Journals 93 

May Summary 137 

Medical Chips of Practical Value 149, 374 

Muscular Rheumatism 156 

Moon 182, 216 

Mouth Hygiene .....195 

Medical Ethics vs. Harpies of Medicine. .208 

Microbes 222 

Medical Thoughts, Facts, Fancies and 

Foibles 264 

Massage in Skin Diseases 277 

Moles 253 

Mullein Oil 261 

Mustard Plaster 353 

Medical Subjects in Lay Publications 355 

Medical Education 375 



New Remedy : 2 

Neofarmans Vaccine in Cancer 21 

Nitrous Oxide Gas and Oxyen Anesthesia 21 

Notes From Practice 27 

New Books. .30 62, 95, 126, 15, 9. i9i, 254, 

260, 286, 318, 382 

Neuralgia 65 

Nondescript Homeopathic Substances 

Used as a Remedy 122, 283 

Nature's Sweet Restorer i39 

Notes from a General Practitioner 156 

Notes from Practice 187, 249 

Nephritis 209 

Nut Bread for Diabetics 246 

Nasal Catarrh 278 

Nose 307 



Our Thirty-Third Milestone i 

Odds and Ends 59 

Optimist a Good Asset 66 



Oliver Wendell Holmes 68 

Obstetric Equipment 162 

Oil of Turpentine 164 

Ophthalmia Neonatorum 196 

Our Advertising Policy zA 

Oatmeal Cure in Diabetes 246 

Oil of Thyme 259 

October Summary V-Z 

Operation for Ing^rowing Toe-Nail. .. .. .259 



Puritus 3, 212 

Pure Food Law 5 

Pernicious Vomiting of Pregnancy 19 

Practical Notes and Replies 25, 185 

Pneumonia 29 

Post-Partum Stage 34 

Predisposing Affinity 48 

Poison Ivy 67, 149, 190 

Pelvic Infection 70 

Placenta Praevia 76 

Postnasal Catarrh 85 

Physician's Extra-Professional Duty 92 

Piles 107 

Pineapple Juice 150 

Puerperium 151 

Peculiar Skin Trouble 152 

Pellagra 197, 245, 3I5 

Patient Devotion 202 

Poliomyelitis 216 

Puerperal Fever ^-253 

Palatable Castor Oil 253 

Pain Habit 258 

Progress in Medicine 290 

Points in Diagnosis 254 

Present Status of Salvarsan 254 

Profession or Trade 261 

Pure Food Agitation 356 

Pneumonia '^1, 380 



Quick Emesis 161 

Quinine in an Agreeable Form 253 

Qualifications for Parenthood 364 



Recurrent Vertigo ^8 

Rheumatism 123, 158, 214, 278, 146 

Remedies for Hjrpodermic Use 146 

Remedies and Measures for Facilitating 

Labor 195 

Rectal Feeding 223 

Rectum in Constioation 233 

Repairs of Wounds 229 

Results of Spinal Injtrries 271 

Reminiscences of a Country Doctor 280 



Spasmodic Torticollis 54 

Sodium Salicylate 68 

Sciatica 74 

Some Suinmer Remedies. 79, 105, 140, 167, 204 

Sane Sanitation 86 

Sick Babies 97 

Sodium Succinate 1 18 

Singultus 119 



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IV 



INDEX TO VOLUME XXXIV 



Sense of Touch in Diagnosis and as an 

Indication to I>irect Treatment 120 

Sitting Up After Labor 157 

Spermatorrhea 163 

Scientific Therapeutics 170 

Systems of Medical Practice 176, 234, 268 

Summer Diarrhea 184 

Strychnine 198 

Some Summary 221 

Sex Hygiene 226, 249 

Soft Dnnks 227 

Spasms of Sphincter Vesicae 244 

Senile Prostatic Hypertrophy 244 

Snake Bite 250 

Sanitation 258 

Simple and Valuable Uranalyses Often 

Overlooked 261 

Standing OflF O^d Age 289 

Superfluous Hairs 316 

Social Problems 232 

Safeguarding Presidents 234 

Sanitary Barber Shops 235 

Stomatitis 256 

Rin^Tworm 381 

Sterilization 354 

Some Forms of Insanity 358 

Splints in General Practice 271 

Some Incompatibles 374 

Sectarian Medicine 379 

Typhoid 21, 26, 38, 61, 89, 90, 117, 125, 381 

Tonsilitis 41 

Thermo-Therapy 43 

The Advertisements (fc[ 

The Abundance of Widows W 

To Young Doctors 81 

The Tongue go 

The Best Tonic We Have 122, 218 

Tuberculosis 130 

Treatment of Gonorrheal Urethritis 131 

Two Instructive Reprints 132 

Trachoma 133 



The Valley of the Shadow 190 

Toxemia of Pregnancy 232 

Too Acid Stomach 253 

Toxic Effect of Magnesium Sulphate 277 

The Age of Ova at Time of Their Impreg- 
nation 281 

Treatment of Neurasthenia by Injections 

of Deep Sea- Water 293 

Taste for Pleasure - . .233 

Tongue 241 

The Mind and Physical Disturbance 

Caused by Ovarian Suppuration 247 

Think for Yourself 354 

Therapeutic Value of the Oxide of Zinc. 357 

Urticaria 372 



Value of Eye Ejtaminations to the Gen- 
eral Practitioner 52 

Vascular Mole 60 

Vertigo 117 

Valvotomy 246 

What Shall I Give the Patient? 36 

What It Was 102 

Which? Why? 159 

Warts 24s, 309, 253 

Wounds 253 

Water Drinking 260 

Why Any Therapeutic Nihilism? 272 

What Has Become of the Old Man? 234 

Warts 375 

Whooping Cough 381 

X-Ray 150 

X-Ray Therapy 372 



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m^ 



A Moolhhr JouniiJ o( 

Practical medicine. New Preparations, Etc 

R. H. ANDREWS, M.D.» CdMer and Publisher, 2321 Park Arm.. ThBm.. P^ 
Oae Dollar Per Aanimi la iklTance. Sia^ Copies. 10 Ceoti 



Vol XXXIV. 



PhiU<IeM>>>. March. 1912. 



Ne.1 



SUB80BIFTI0R &ATB8: $1.00 per yser, In ed- 
Taaee, to aar part of the United Stetei and 
Hezieo. To Foreign OOvntriei and Canada, $1.86. 

HBW SXTBSOBIPTIONS may begin at any time dar- 
ing the year. 

HOW TO BEMIT: A safe way to remit is by postal 
money order, express order, ebedc. draft, or regis- 
tered mail. Onrrenet sent by ordinary mail nsn- 
slly reaehes its desnnation safely, bnt money so 
sent mnst be at the risk of the sender. 

BSOEIPTS: Tha receipt of all money is immedi- 
ately aeknowledged by a postal card. 

0HAVGB8 OF ADDBE88: Snbseribere ehanging their 
addreeees should immediately notify ns of their 
present and past locations, we cannot hold onr- 
seWeo responsible for non-receipt of the Jonmal 
in sneh cases, unless we are thns notified. 

DIBCOJITiJI U AV0B8 : The Summary is continued to 
responsible subscribers until the publisher is noti- 
ied by mail to discontinue, when payment of aU 
If yon do not wish 



by mail to discontinue, when pa 
4zreai«ges mnst be made. If yon 
The 8nmmary continued for another year after 
the time paid for has expired, please notify ns to 
that effect. 



"THE MEDICAL 8U1CMABT,'* 



2381 Park Ats., 



Philadelphia, Pa. 



Entered at Phils. Post OiBce as second-class matter. 



OUR THIRTT-THIRI) MILESTONE. 

The editor of the Summary takes a par- 
donable pride in heralding the fact that he 
has presided over the destinies of this jour- 
nal for thirty-three years! During these 
years many changes in the practice of med- 
icine have taken place, and our therapeutic 
resources have been in many ways greatly 



enriched. A great many fads and theories 
have had their little cycle of exploitation 
and then vanished. We have always in our 
journalistic career endeavored to pursue a 
conservative course, retaining all the old 
that is time-tried and true and adoftltg 
the new as rapidly as it is proven worMiy 
of consideration. 

And that is our policy for the fntttre. 
The Summary has never posed as a scien- 
tific journal per se. We endeavor to reflect 
the profession as it really is, not as it 
should be. Our space has ever been given 
largely to the clinical and practical side of 
medicine; it will continue to do so in the 
future. Our appeal is to the doctor on the 
firing-line rather than the academician. 
The Summary will continue to be just as 
helpful and as practical as we can make k. 
We publish no long articles; we do not 
care to publish anything that is not usable. 
The Summary was never so prosperotM as 
now, and we owe our success to our great 
army of general practitioners who sEb- 
scribe for it year after year. Our adver- 
tisers have stood by us nobly, and we thank 
them for their loyal support. In this con- 
nection we also wish to attribute a lair 
measure of the journal's success and use- 
fulness to the faithful contributors lo oar 
reading pages. We pray for the continued 
support of all these during the years to 
come. In the language of the immortat Rip 
Van Winkle, "May you live long nnd 
brosper." 



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THE MEDICAL SUMMARY 



.J Ji .B.JIJS1I 



.'A NEW (?) R£M£DT. 

Man in the uncivilized, primitive state be- 
lieved that he could acquire some of the 
strength of a brave and powerful foe by 
killing him and feasting upon his heart. 
Some sort of extract has been derived for 
medical purpose from almost every organ 
and tissue of the human body. Some few 
of these — not very many — ^may exert some 
benign therapeutic action. We have just 
read of some scientist who has been em- 
ploying the fluid drawn from a hydrocele 
for the purpose of arresting hemorrhage. 
It is also claimed to be a diuretic and to 
inhibit microbic action. It can be injected 
into the peritoneal cavity, but we are told 
that more than one good, stiff dose may 
cause "anaphylactic reaction" — whatever 
that is. We don't know what it is; more 
we don't care. Not that we have the least 
desire to belittle any scientific achievement 
But honest, doctor, would you care to have 
hydrocele juice squirted into yourself or 
any of your family? 



A DOCTOR'S STORY. 

We hear a good deal said of the ingrati- 
tude of people toward the doctor; he is so 
often underpaid and if he makes a mistake 
it is too often taken advantage of by some 
unscrupulous person. Again, when the 
physician is unsuccessful so far as saving 
life is concerned or otherwise conducting 
the case to a satisfactory termination, too 
often he is the recipient of adverse adver- 
tising. Too often a doctor's reputation has 
suffered over little matters when he was 
putting forth his most earnest and con- 
scientious efforts. To further illuminate 
this text, we present this experience of the 
venerable Dr. C. A. Bryce, editor of the 
Southern Clinic: 

"A number of years ago a gentleman, 
whose home was in one of the upper coun- 
ties of this State, came to us for relief 
from organic stricture. He was the broth- 
er of a physician of some prominence, arid, 
as well we remember, brought a letter from 
him, requesting us to do all we could for 
him in every way. The man was a lawyer 



by profession, but held some ofl&ce in tht6 
city at the time he placed himself in opr 
care. After offering him the various oper- 
ations he asked us to divulse his stricture, 
and not to give him an anesthetic. He 
was very fearful of pain, but more so of 
chloroform or ether, and we compromised 
by giving him a tablet of i/6 of a grain of 
morphine, and a drink of whiskey about a 
half hour before operating. The operation 
was ideal, so far as such a rough procedure 
can be called ideal, for there was no hem- 
orrhage, the fibrous bands giving away 
without injury to the mucous membrane, 
and full 28 to 30 F. sounds passed easily 
into the bladder. 

"Just as we were leaving him, in fine 
shape, at II o'clock in the forenoon, he 
said : 'Doctor, Vm going to take the other 
tablet; I'm afraid I'm going to have some 
pain after you all are gone.' (The late Dr. 
J. R. Nalle was with me and ably assisted 
me.) We advised him not to take it, but 
there being only one tablet of 1/6 grain of 
morphine, we felt it would not amount to 
anything if he should take it, as he could 
have only 1/3 grain in all. We promised 
to see him before bedtime, and left word 
with his mother, who was the only person 
in his room, to let us know if anytiiing oc- 
curred to demand our attention before our 
visit. His mother was quite an aged lady, 
and it seems was spending the winter in 
the city to be with her son, and on this 
occasion was his only attendant. 

"About 7 o'clock in the evening a gentle- 
man rushed into our office and urged us to 
hasten to see the patient upon whom we 
had operated that morning. He added that 
he believed that he was dying. We found 
the man cyanosed, pupils contracted to 
mere points, and respirations reduced to 
four or five per minute. He was dead in 
ten minutes. 

"Somehow on these occasions a room is 
soon filled with friends, idlers and curios- 
ity-struck people, and it seemed that as this 
unfortunate man drew his last breath the 
room and hallway were literally packed, 
and all wanted to know what was the cause 
of his death. We never felt worse about a 
case in our life. It was a shock to us, and 
we questioned ourself as to the possibility 
of an error on our own part, as any physi- 



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THE MEDICAL SUMMARY 



cian would have done at the first moment. 
The case was plainly one of some narcotic 
poisoning. We told the people that in our 
opinion, the man died of opium poisoning, 
and if. he only got what we gave him, he 
died from 1/3 of grain of morphine ad- 
ministered by us; but we believed he got 
something else besides what we gave. 

"While no one had said directly that we 
had overdosed our patient, it was pretty 
generally understood that our mistake had 
killed him. We were puzzled over the mat- 
ter, greatly worried, and finally concluded 
that the poor fellow must have died from 
susceptibility to small doses of morphine. 
We got the credit of a terrible mistake, 
which spread very rapidly over the ci^. 
We wrote a full history of the case to his 
brother (the doctor) and expressed our 
sorrow over the event He did not have 
the decency to reply to our letter. When 
we mailed him a bill against the estate of 
the deceased, we received just this reply 

from his brother: ' left no estate.' 

This is all the thanks and all the pay we 
ever received for our sympathy and our 
services. Now here is the hard part. Sev- 
eral months after this tragic ending, and 
after we had suffered in mind and in loss 
of practice, the gentleman at whose house 
this man died came to us and said that he 
couldn't stand it any longer keeping a se- 
cret which we should know. He said: Til 

tell you what killed K . He sent out 

after you left, and bought a quart of bran- 
dy and drank nearly all of it before they 
sent for you. Brandy killed him, not your 
medicine.' That man and the relatives Imew 
the cause of the patient's death, and never 
lifted a voice to relieve our feelings or save 
our reputation, and finally beat us out of 
our bill. It is a mistake to sympathize with 
ingrates or to 'cast pearls before swine.'" 



CARE OF TH£ SCALP. 

Persistent attention is the price of a 
clean, healthy scalp and hair. Massage 
daily with the fingers and to the extent of 
loosening the scalp will make more toward 
a healthy scalp than any other routine. 
Healthy and clean hair cannot grow from 
an ' abnorntar scalp. The hair roots and 



sebaceotis follicles need a sort of passive 
exercise. ' The scalp should also be brush- 
ed daily with a suitable brush in all cases 
where dandruff or falling hair occurs. This 
should not, however, be overdone and to 
the extent of creating a soreness of the 
scalp. If the hair is too oily a preparation 
of salts of tartar or ammonia in some form 
may be applied occasionally. Usually the 
hair is too dry in abnormal conditions of 
the scalp and hair, so that a little vaseline 
or other oleaginous substance is occasion- 
ally indicated. The best hair tonics contain 
quinine. Capsicum, cantharides and other 
agencies are of value in many cases. The 
following makes an excellent tonic for fall- 
ing and lifeless hair: 

^ Quinine sulphate 5iss 

Tincture cantharides* 3ij 

Glycerin ^s 

Oil anise gtt xij 

Witch hazel. ^^iij 

M. Those who have had experience in 
this matter state that this tonic should be 
used every night for two weeks, after 
which the head should be washed in a suds 
made from green soap. The treatment 
should be suspended for about a week, and 
then resumed for another two weeks. This 
is kept up tmtil the scalp becomse healthy 
and dandruff ceases, when the hair be- 
comes glossy and ceases falling out 



A CORRECTION. 



Top line, right-hand column, page 381, 
February Summary, Dr. Bradley's address 
should have been Hamlet, instead of Ham- 
ilton. Also, the article on page 378, entit- 
led "Pneumonia with a Sequel of Pleurisy," 
was written by G. O. Smith, M.D., of 
Odessa, N. Y., instead of Dr. Pons, whose 
article appears in the present issue. 



PRURITUS. 



Equal parts of eau de cologne and water 
applied on lint and kept moistened are of 
value; also the moistening of the skin with 
lavender water. A hot bath preceding 
these applications makes the remedies more 
effective. Lead lotions are useful 



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THE MEDICAL SUMMARY 



\ 



"JUST OHE EXAMPLE." 

In a scurrilous little article captioned as 
above, the A, M. A, Journal of February 3, 
takes a fall out of several of the better- 
class independent journals, the Summary 
included. The above-named Journal, being 
an embodiment of all that is virtuous and 
holy, it simply throws a fit when it sees sis- 
ter journals departing from the straight 
and narrow path. The "nostrum evil" is a 
thorn in the side of said Journal and its 
coterie of individuals who make its exis- 
tence possible. It weeps and worries be- 
cause it can not put all the nasty, imspeak- 
ablc proprietaries out of business. From 
the perusal of its immaculate pa^es one 
would believe that the Journal hates nos- 
trums and proprietaries like the devil hates 
holy water. 

And still, let's try to harmonize a few of 
its inconsistencies. The Journal fairly turns 
its gorge at the mention of any preparation 
not approved by the Council of Pharmacy, 
yet these same preparations when christen- 
ed by Other names and given the stamp of 
approval by "those having authority," the 
Journal's esthetic stomach does not rebel. 
Its listerine must be called Liquor Antisep- 
ticus, and its antiphlogistine Emp. Kaolin 
Comp. All the time-honored proprietaries 
that have after years of faithful servitude 
proved their therapeutic worth and right to 
stay have been duplicated by the little clique 
who are endeavoring to tell physicians what 
they may prescribe and what they shall not. 
If the original preparation is wrong and its 
use by physicians unethical, why is it not 
wrong to duplicate it and call it by some 
other fanciful name? If one is wrong, both 
are wrong. Proprietary preparations that 
are truly meritorious will be prescribed by 
physicians in spite of all the censorships 
that may be placed over them. The proof 
of the pudding — ^you know the' rest. 

But the specific charge against the Sum- 
mary is for carrying ati advertisement of 
Duffy's Malt Whiskey ! Isn't that a heinous 
crime? That was the only thing in the 
Summary with which the Journal could 
pick a flaw. We have ever exercised scru- 
tiny in accepting advertising matter and 
do not carry such as is calculated to de- 
ceive. We believe that the majority of 



physicians at times prescribe alcoholics, so 
we may not after all be open to such vio- 
lent censure for carrying this whiskey adv. 
It is intimated that the Summary and 
the other journals named arc "advertising 
Sheets." Well, advertising is a fine art 
these days, provided the articles advertised 
make good. With mighty few exceptions 
everything advertised in these pages is 
worthy and commendable; otherwise we 
would not accept them. But the Summary 
is above all else a purveyor of practical 
information to practical physicians. Every 
issue is filled with this kind of matter. We 
cater to the general practitioner in a way 
that the A. M. A, Journal does not. Just 
this week an Ohio physician writes: "The 
Summary contains more good helpful medi- 
cine in one number than the A, M. A. Jour- 
nal contains in six months, weekly issues." 
Similar reports come to us constantly, which 
goes to show that we furnish doctors the 
kind of material that is really helpful in 
their every-day practice. Failing in its ef- 
forts to annihilate the promoters of laud- 
able proprietaries the Journal is renewing 
its hostilities against the independent jour- 
nals that carry advs. against which the 
righteous Journal has sworn eternal ven- 
geance. As an after-thought, why don't 
the Journal and the Council get together 
and produce an imitation of the Duffy 
goods and ethicalize it? Spiriticus f rumen- 
ticus Americanus might do. 



"GRIP." 

This term, like charity, is lacking in per- 
spicacity and may cover a great many med- 
ical sins. Correctly speaking, we have no 
such thing as grip. At least scientists tell 
us that no specific causative germ is in evi- 
dence. Some of the somewhat benign mi- 
croorganisms of other kind may, however, 
be present in the nondescript condition 
passing as grip. It would perhaps be well 
if this rather elastic, and sometimes con- 
venient, term were expurged from our lit- 
erature and colloquially dropped. 



Pain in the feet is often ascribed to rheu- 
matism when it is only due to weakness of 
the arch« and can be immediately removed 
by proper support. 



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THE PUSS FOOD LAW; HOW SIDE- 
TSACKBD AND THE RESULTS. 



By C. W. Canan, B.S., M.D., Ph.D. 

When the pure food law went into eflFect 
there was general rejoicing by the people 
of this nation; and not only by the people 
of this nation, but by those of every nation 
that consumed any of our products. All 
agreed that this safeguard to the public's 
life and health had come none too soon, for 
the eril had assumed wonderful propor- 
tions. Millions of dollars were stored away 
each year by the manufacturers of the va- 
rious food products, by doctoring refuse 
and spoiled meats that would have been 
an absolute loss. The people were over- 
joyed at the passage of so wise a measure. 
They said now when we buy a product and 
see the stamp of the pure food law upon it, 
we can consume without any further fear 
that bad results would follow. The Gov- 
ernment stands between the manufacturer 
and the consumer, and the food must be 
right from this on. 

The motive was good and the results 
would have been beyond human computa- 
tion had not greed for rapid gain stepped 
in and caused justice to ^^miscarry. That 
the law has been thwarted there is ample 
proof, and along many lines it is no more 
than a hoax fostered upon an over-confi- 
dent public While the bill was being 
worked through a close observer could have 
read the ''handwriting upon the wall." But 
the fight was won for the masses, and it is 
a shame to a civilized nation that a law so 
potent for good had to be side-tracked al- 
most in its infancy. 

Let us look into this matter and see who 
thwarted it from its object, that of secaring 
nonadulterated food for a hungry nation. 
For, as we will show later, it has been al- 



most, and along some lines, absolutely shoni 
of its power. 

Close upon the heels of its passage the 
plot was laid. The great food-producing 
factories and corporations, with their mil- 
lions of dollars behind them, (made by 
doping refuse and half-decayed meats), saw 
at a glance that there was much larger 
profits in manufacturing impure food than 
they could ever make by producing it pure. 
Therefore some way must be discovered to 
clip the wings of the pure food law. This 
must be done in such a way that the Gov- 
ernment, and especially those in its em- 
ploy who so bravely and so heroically cham- 
pioned the cause, would not suspect their 
object. They claimed that if this new law 
was enforced to the letter it would pre- 
cipitate a business panic, such as this coun- 
try had not seen for years, and hundreds, 
of business men would go to the wall. That 
there were millions of dollars worth of 
food either in process of manufacture or 
in the hands of wholesalers, jobbers and 
retailers. That it was better for the peo- 
ple to endure the old state or condition, say 
for one year, when in this time they could 
adjust themselves and turn out pure food, 
than to precipitate a panic in business that 
would be felt for years and years. The 
Administration was an easy mark, and the 
whole output for that year had the pure 
food stamp put upon it, and yet was the 
same adulterated stuff that the law was 
created to condemn. The people were 
duped again. Strange state of affairs there, 
but money in the hands of unscrupulous 
people can and do thwart the ends of jus- 
tice. 

Their success in this matter made them 
more eager for a second victory. This was 
to clip the ¥rings of that most estimable 
gentleman. Dr. H. W. Wiley, the greatest 
champion of the pure food cause this coun- 
try has ever had, and probably ever will 



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THE MEDICAL SUMMARY 



have. They knew that he was no friend to 
their nefarious schemes. They fully un- 
derstood that his knowledge of chemistry 
would be their undoing. Being chief chem- 
ist of the Agriculture Department, he was 
in their way. And yet they dared not op- 
pose him openly. Therefore these powers 
for evil went to work in the dark. They 
openly praised Dr. Wiley's work in cham- 
pioning the pure food cause and wished 
that the country contained more men like 
Dr. Wiley. But they said that the food 
question was world-wide, that it was intri- 
cate, and that many difficult and perplexing 
questions arose; therefore no one man could 
always be right in his decisions of these 
mooted questions, no matter how learned 
he was or how unerring his judgment 
That to decide the food question, for a 
nation like ours, to say nothing of foreign 
nations, whose tastes differed very mater- 
ially there should be a board of chemists 
appointed to co-operate and advise with Dr. 
Wiley. 

Those who could read between the lines 
saw the following : so that this board could 
over-rule Dr. Wiley's decisions. Ex-Presi- 
dent Roosevelt, with all his will-power and 
self-importance, became "an easy hit," and 
appointed the "Remsen Board." Dr. Wiley 
«soon found himself unable to protect the 
people from using adulterated and poison- 
ed food. This Board has over-ruled his 
wise decisions and misinterpreting the law 
in many of its phases until the state of af- 
fairs are deplorable, and the pure food law 
has become a hollow mockery. The Gov- 
ernment has been duped and Dr. Wiley and 
all those who championed this great cause 
have been handicapped. 

Think of it, food placed upon the market 
bearing the Government stamp for purity, 
and at the same time containing adultera- 
tions and poisoning, rendering it dangerous 
to the consumer. 

The reader will naturally ask, how does 
the writer know that such a state of affairs 
exists; that our food stuff is adulterated 
and that the label guaranteeing purity has 
become a jest, and is actually misleading 
to the consumer? Last summer the writer 
began an investigation, and the following 
are §ome of the discoveries he made : 

Take the "poor man's butter," oleomar- 



garine, and the pure food law would have 
us believe that we are eating nothing worse 
than cottonseed oil, when the fact is he is 
only eating from 15 to 25 per cent, of cot- 
tonseed oil; the remainder being made up 
of neutral lard, oleo oils and other refuse. 
Neutral lard is hot fat that has become so 
rancid that it is worthless and can not be 
sold for cooking purposes. Oleo oil is only 
another name for tallow and impure fats 
of cattle and sheep. This refuse is treated 
with chemicals removing the rancidity and 
rendering it odorless. This is called neu- 
tralizing. The chemicals used are injurious 
to the human stomach. When you remem- 
ber that about ninety-five million pounds of 
this substance is consumed each year, and 
that it only cost about six and one-eighth 
cents per poimd to manufacture, the object 
of adulteration can readily be seen. 

The writer found ice cream that did not 
contain one-fourth of even poor milk. It 
was composed of lard, cornstarch, gum 
(bleached), glucose, flavor and coloring 
matter. One sample contained tallow and 
another soap. Many of the flavors used in 
ice cream and soda water were etherials, 
and the coloring matter used were analine 
dyes. 

The cheap candies are as a rule unfit to 
enter the stomach of an ostrich, much less 
a human. The filled candy is the worst. 
Glucose, lard and tallow treated with sul- 
phites to render them white and to remove 
all rancidity and odor enter into their com- 
position. Many of the ornamental candies 
for Easter and Christmas are filled with the 
above and covered with cheap furniture 
shellac, into which chocolate has been 
mixed. Others are colored with the ana- 
line dyes. 

popcorn balls and squares were found 
stuck together with glucose whitened with 
sulphites, producing the sweet taste and 
causing the grains to adhere. One could 
hardly find a substance more indigestible 
than this popcorn, unless he would want 
to try brick-bat's. 

Benzoate soda, the sulphites, salyciiic 
acid, oxalic acid, coal tar products, and 
many others are used in ' adulteration of 
foods, hot so openly as before tiie pure 
food law, but suiBicient to become' alarm- 
ing. Some of the ^bove-fiamed drugs are 



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THE MEDICAL SUMMARY 



used as bleachers, others as preservatives, 
and still others to remove rancidity, kill 
odor, and to restore the color to spoiled 
meats. A typical representative of this last 
class is a powder called "Jerusalem." In 
making hamburger steaks this powder is 
used to remove the odor and restore the 
bright red color to meat that has partially 
spoiled and turned black or dark. 
Orkney Springs, Va. 



CLINICAL EXPERIENCES WITH INTRA- 
VENOUS MEDICATION— RESULTS 
AND TECHNIC. 

By p. B. Thatcher, M.D. 

(Concluded from the February Number.) 

Mr. C. L., age 34. — Bad results of over- 
woric. R. B. C. 4,980,000. Hem. 85%. Pale, 
under weight, indifferent appetite, smokes 
too much. Treatments September 7, 17, 27, 
October 17. Gained eight pounds after 
third treatment. Decidedly better generally. 
R- B. C. 5,500,000. Hem. 95%. 

Miss H. G., age 19. — Anemia and acne. 
Frequent headaches, conjunctiva pale, pain* 
ful scanty menses, no appetite. Treatments 
September 4, 14, 22, 29. Acne not improv- 
ed, no headache after second treatment, 
menses normal, good appetite, feeling much 
better generally. 

Mr. C. K., age 35. — Anemia and debility 
from overwork. Patient has been losing 
weight and appetite for past few months, 
mainly due to business worries. Becoming 
paler and more listless, until his wife insist- 
ed upon his consulting me. Treatments 
September 21, 29, October 10, 20. Patient 
gained one pound in weight each day for 
the first week. Weighed on the same stan- 
dard scales at his oflSce. Total gain in 
weight, 16 pounds. Entirely well. 

Mrs. T., age 29. — ^Anemia and general 
debility. Patient had lost 12 pounds in 
weight; no appetite; frequent severe colds; 
headaches three or four times each week; 
pale, listless, unable to perform her usual 
household duties as she had been accus- 
tomed to do. Treatment September 21, 
October i, 11, 18. Now feeling fine; good 
appetite and appearance ; entirely well. 

Mr. J. G., age 56. — Slight paralytic stroke 
18* mdriihs 'ago. Patient appears -to be in * 



perfect health, fine appetite, but thought this 
treatment would lielp him, owing to the 
constant tingling he has, causing him to 
live in daily dread of another and more se- 
vere stroke, the previous one from which 
he has apparently completely recovered. 
Treatments September 28, October 10, 21, 
November 4, 14. Tingling and all other 
impleasant sensations gone. Feeling fine, 
greatly pleased, and apparently entirely 
well. 

Mr. A., age 70. — Complete prostration 
from grippe. Patient came most unplea- 
santly close to pneumonia. Death impend- 
ing from resulting dangerous prostration, 
from which he was unable to rally. No re- 
action could be obtained by any supportive 
treatment Cardiac involvement. Treat- 
ments November 27, December 4, 17. Won- 
derfully better after second treatment 
Could not get enough to eat, and is now 
taking walks on the sunny side of the street 

Miss Y., age 3&— Chronic asthma, dura- 
tion 15 years. This patient has had almost 
continuous disability from the stated condi- 
tion for the above length of time. She 
was compelled to inhale some sort of dope 
every night for the three months preceding 
the first treatment, and often twice in the 
mornings. Treatments November 15, 21, 
December i, 15. The night of the after- 
noon on which she received the first treat- 
ment, she slept all night, which was the 
first for three months. She has only had 
to smoke five times since the first treatment, 
one of these occasions being after she had 
ironed all day because she was feeling so 
much better. 

Mrs. D., age 52. — Typical neurasthenia; 
imaginary ills. Two treatments at weekly 
intervals. Patient then decided not to con- 
tinue treatment, as she felt so much better 
that she was afraid her heart would not 
stand it These ate almost her exact words. 
She complained of feeling better. 

Mr. S., age 26, Pulmonary tuberculosis. 
Referred by Dr. Riegel, who verified diag- 
nosis. Patient had been advised to seek 
another climate. In addition to usual con- 
dition, complained of complete loss 'of sen- 
sation in total anterior part of one foot, 
from center of foot downward. Pain in 
thigh of same leg. Treatments November 
27, Ef^cetpb^r 4,:,ii,, i8. Complete return 



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THE MEDICAL SUMMARY 



to aormal of foot and thigh. Gain of three 
pounds after first treatment. Now gaining 
steadily, is greatly encouraged. 

ft will be noticed that in only two of the 
serenteen cases reported, was it possible to 
secure a blood count. This is due in part 
to the fact that we have no clinical labora- 
tory in this part of the city, and patients 
will not go into the center of the city for 
this purpose. Others object on the ground 
that the prick of the needle when securing 
the blood is more painful than taking the 
treatment. This lack of accurate scientific 
data will be obviated in the future, as our 
facilities will enable us to have a blood 
<ovmt made as a matter of routine in the 
treatment, through the adjoining laboratory 
to our new offices, of Mr. John Hicks, who 
is specializing in this work. 

Physicians deciding to use this solution 
sliodd carefully and exactly follow the sim- 
ple fechnic herein described. Any results 
causing discomfort of any kind to the pa- 
tient, are invariably due to carelessness or 
ignorance in the technic, with the excep- 
tion of those cases where the vein proves 
to be unexpectedly too small. . 
Technic. 

In the administration of Bannerman's 
latra-venous Solution, it is absolutely essen- 
tial to use an all-glass syringe, in order that 
the blood may be visible in the syringe, 
which proves that the needlo has properly 
entered the vein. A five-eighth inch, twenty- 
seven gauge needle is used. This is the 
smallest gauge needle made. 

The largest vein in evidence is selected, 
usually one at the elbow, the median basilic 
if possible. The arm at the point of the 
proposed injection is cleansed with alcohol. 
Pressure is applied above the elbow by 
means of a twisted cloth, causing greater 
firmness and prominence of the vein. Never 
tie the cloth, as it is then impossible to re- 
lease the pressure after the needle has been 
placed, without great danger of displacing 
the needle. The needle is firmly attached 
to tfie syringe, the plunger withdrawn, the 
syringe inverted, and then filled with the 
desired dose, tfie average being lo c.c 

The plunger is then replaced, and all air 
cmrefttlly excluded from the syringe, which 
ia Uien grasped by the thumb and forefin- 
ffer of die right hand on the barrel, with 



the middle finger jammed against the plung- 
er, where it enters the barrel of the syringe. 
This is the correct way of holding the 
syringe when entering the vein. The force 
is exerted by the thumb and forefinger on 
the barrel, while the middle finger prevents 
the plunger from slipping either way pre- 
maturely. 

The needle should be wiped dry with 
sterile cotton just before puncturing, in 
order to avoid the irritating effects of the 
solution to the subcutaneous tissue, causing 
a bruised effect. 

Entrance should be effected slowly, with 
the arm dependent, fist of patient clenched 
to tighten vein, and the syringe below the 
point of insertion. This position of the 
syringe will allow the blood to flow down 
through the needle into the syringe, as soon 
as the vein has been entered. Until this 
dark venous blood is plainly and unmistak- 
ably seen in the nib and barrel of the 
syringe, the injection must not be started. 
If the blood does not appear, withdraw the 
needle and try again. The angle of inser- 
tion must be calculated so as to bring the 
needle into the lumen of the vein. Do not 
fish around too much trying to locate the 
vein with the needle inserted, as this will 
cause more or less laceration to the tissues, 
with subsequent pain and soreness of the 
arm. Go straight in and straight out, as 
nearly as possible. 

When the needle has entered the vein 
properly, as is plainly demonstrated by the 
presence of the venous blood in the syringe, 
the pressure above the elbow is carefully 
and cautiously released, in order not to dis- 
place the needle. The left hand of the 
operator then supports the syringe, and nis 
right hand is carefully shifted to the posi- 
tion for injecting, care again being taken 
not to displace the position of the needle. 
The position for injecting is in having the 
first two fingers of the right hand of the 
operator gently pulling against the finger 
stirrups on the syringe, while the thumb of 
the same hand slowly drives the plunger 
down. 

A most important point is this : This so- 
lution must be given as slowly as possible, 
the plunger barely moving, and fully three 
minutes being required for the entire in- 
jection. If the solution is given too rapid- 



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THE MEDICAL SUMMARY 



\y, bulging of th« vein occurs, with pain to 
the pati«nt, the vein will not take up the 
solution, and it will be necessary to with- 
draw the needle, and select another vein. 

This will even occur at times when all 
apparent precautions as to rate of speed 
have been taken, and the patient may be 
informed accordingly, also of the fact that 
it is not always possible to strike the vein 
at the first attempt. Should the vein en- 
tered prove to be too small, or the injection 
be given too rapidly, and this puffing of 
the vein result, no fear need be felt as to 
any harmful results whatever. The pain, 
however, is quite severe for a few moments, 
and the patient does not hesitate to tell you 
all about it This solution should never 
cause the slightest pain while being inject- 
ed, and when such occurs, the treatment 
must be immediately stopped, and hot com- 
presses applied. The same severe burning 
pain is usually felt when the solution is go- 
ing into the tissue adjacent to the vein. 
Neither patient nor operator should feel 
discouraged at these small mishaps, as they 
will occur in the best regulated families. 
This does not appjy to the solution being 
given hjrpodermically, for which there :s 
no excuse. 

At the conclusion of the injection, the 
plunger of the syringe is pulled back slight- 
ly before withdrawing tiie needle. This 
will fill the needle with blood, of which a 
small amount will be deposited under the 
skin when the needle is withdrawn, instead 
of this amount of solution, thus avoiding 
the bruised effect of the solution on the 
tissue external to the vein. 

Apply six or eight hot compresses as 
soon as the tr^tment has been completed, 
or instruct the patients to do so as soon as 
they return home. 

The patient should receive the treatment 
in a reclining position if any S3rmptoms of 
nervousness are apparent. The writer 
fainted when he was vaccinated, which is 
about the limit for imaginary foolishness. 

After one or two treatments, however, 
the patients will come into your oflSce, roll 
up their sleevea, take the treatment sitting 
easilj on a chair, and go on their way re- 
joicinf , thinking less about it than the re* 
oioval of a anitr from the eye. The taste 
of the creasote is usually almost immedi- 



ately noticeable, followed by a warm flush 
throughout the body. 

Care is taken in withdrawing the needle, 
which is done rather slowly to avoid 9ny 
remote possibility of air entering the vein 
through the minute puncture. A small 
pledget of sterile cotton is pressed lightly 
against the skin at the point of withdrawal. 
As the needle leaves the vein, the skin im- 
mediately covers the tiny puncture, and the 
cotton in turn protects the small ptmcttire 
in the skin. 

Any discoloration or slight soreness of 
the arm will disappear within the course of 
a day or so. When the above technic is 
carefully followed, there will usually be 
nothing unpleasant noticeable. Great care 
must be taken that the point of the needle 
does not become dislodged after the in- 
jection has been started, which could easily 
occur by a sudden unexpected movement of 
operator or patient. The proper position of 
the needle in the vein can always be veri- 
fied at any time, by stopping the injection, 
and slightly pulling back the plunger, when 
the blood should again appear in the syringe 
as at first. 

Since needles corrode easily, causing dif- 
ficulty in penetrating the skin, a new needle 
should be used for each treatment. 

If this solution is given hypodermicaliy, 
in any considerable amount, a local abscess 
will surely develop. While very unplea- 
sant to the patient, it is local in character 
only, and cannot cause any general septic 
condition. 

As a perfectly constructed syringe is es- 
sential for safety and success in this type 
of intravenous work, I have no hesitation 
in here stating that Mr. Frank B. Ross, of 
Fifty-second street and Haverford avenue, 
Philadelphia, has had a lo cc. Luer all- 
glass syringe made especially for this work. 
The price of this syringe is $4.50, including 
metal case and two needles. The William 
Bannerman Co., Chicago, supply an equally 
good syringe. This announcement is made 
in the interests of those contemplating the 
use of this solution. Other syringes on the 
market have been found to be unsatisfac- 
tory and dangerous for this work. 
Conclusion. 

The free highway of the blood current is 
the coming carrier for certain desired re- 



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10 



THE MEDICAL SUMMARY 



suits in definite medication. This logical 
conclusion has now been reached by inves- 
tigators of authority, both here and abroad. 
It should be a matter of some pride to us^ 
that we are enabled to use a method which 
is now in the very forefront of medical 
progress. 

In the Glasgow Medical Journal, Dr. 
Thomas W. Dewar reports the germicidal 
effects of iodoform used intravenously in 
phthisis. He states that this action may be 
due to "the excitation of the micro- and 
macrophages of Metzhnikoff, aiding their 
phagocytosis at the point where the defence 
is crumbling." This would apply with equal 
force to the creasote in this preparation, 
which has the additional great advantage 
of being nontoxic. 

A phase of this treatment presenting in- 
teresting future possibilities is that relating 
to the prevention of a possible coming ill- 
ness in those who are worn out with the 
ceaseless business grind, or social whirl. 
The response to these treatments in in- 
creased vitality offers great promise of re- 
lief for this class of cases. 

So far as that chronically pessimistic 
portion of the profession is concerned, who 
look with dull foreboding upon the advanc- 
ing march of medical progress, and who 
are buried neck deep in the rut of "things 
as they are," I fully realize that they will 
undoubtedly presume to condemn some- 
thing of which they know nothing. El- 
bert Hubbard has aptly said with ref- 
erence to the narrow minded man, that 
"what he is liot up on, he is down on." 
When the Wassermann test was announc- 
ed it was scoffed and derided, which 
did not prevent it, however, from soon be- 
ing universally recognized. When Harvey 
announced the discovery of the circulation 
of the blood, many members of the profes- 
sion at that time were strongly in favor of 
having the death sentence pronounced upon 
him. 

Dr. Hackney and myself have now given 
this treatment close to four hundred times, 
with no bad results whatever. We have 
taken the treatment oursdves and have 
given it to our families. Including Dr. 
narrower, we have not one cent's worth 
of stock in the William Bannerman Co., 
and we all pay precisely the same as any- 
one else for all the solution we use. 



I have frankly presented this paper with 
the earnest and sincere wish that yoa 
obtain for yourself and your patients the 
same results we have secured, it honest, in- 
vestigation proves our statements to be true. 

Apropos of him who doubts and does not 
try to know, American Medicine, Junc^ 
191 1, states: "Too much skepticism is not 
wise at the present day. The impossibili- 
ties of yesterday are well established phe- 
nomena of to-day. It does not pay to deny 
the possibility of anything pertaining to the 
so-called natural phenomena, or life itself. 
To pause and consider the many things 
commonplace to-day, that a few short years 
were not only unknown, but actually be- 
yond the mental grasp of our fathers, can- 
not help to make one hesitate to question 
the possibility of any occurrence dependent 
on or associated with natural phenomena. 
The discovery of some simple little fact^ 
seemingly unimportant, may render a whole 
group of phenomena compreiiensible, and 
these in turn may make a whole chain of 
erstwhile mysteries and apparent impossi- 
bilities so plain and commonplace that one 
will be less amazed at the new discoveries 
than at the failure to grasp them before/' 

711-712 Flanders Building, 

15th and Walnut Sts., Philadelphia. 



DIAGNOSIS. 

By D. L. Field, jM.D. 

A physician can't be too careful and 
painstaking in his efforts to arrive at a 
correct diagnosis. The best of us are often 
stumped, or may be much mistaken. I had 
a case which I felt sure was either gall- 
stones or catarrhal jaundice, and after a 
good while of futile treatment he died. 
The autopsy revealed a twelve-pound liver 
and a three-pound spleen. How was that 
for a diagnosis? Howeveri he would not 
have recovered, anyhow. 

Another case I treated for Bright's dis- 
ease, but a chemical and microscopic anal- 
ysis proved my mistake, and I found that 
his blood pressure was 230 degrees. Cut- 
ting him down to spare <iiet, with no ani- 
rtal food, and using eliminants, he is rapid- 
ly improving and I expect to bring his 
blood pressure down td iso-degrecs; <. I used 
hot baths also. 



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THE MEDICAL SUMMARY 



II 



I was called to see a woman, whom an- 
other physicialn had been treating for a 
good while for gaseous distension of the 
abdomen. I promptly infornled both her- 
self and husband that I believed she had 
ovarian tumor, with dropsy of the sack. I 
called the late Dr. Cartledge, of Louisville, 
who was an eminent surgeon, and he soon 
after operated, removing an ovarian tumor 
which filled a foot tub. She is now in fine 
health. I was right that time. 

Several years ago a man and wife re- 
moved here from Scott county, and she was 
there treated for cancer of the stomach. 
When I saw her here I thought she was 
so diseased. She became bedfast, vomited 
the oflfensive stuff almost constantly, and 
all I could give her was milk and lime 
water, which would not stay down long. 
The odor from her breath was so bad that 
I sprayed the room and bed with deodizers. 
I had no hope of doing her any permanent 
good by treatment, and gave morphine hypo- 
dermically for gastric pain. I was sure she 
had an advanced case of cancer. In order 
to deoderize her breath, as well as anas- 
thetize the nerves of the stomach, I began 
giving her small doses of carbolic acid, 
two drops in a tablespoonful of water, about 
every three hours. I had not given it very ' 
long until it eased her pain so much that 
1 ceased the hypodermics. In the course 
of three days her sick stomach and vom.it- 
ing ceased. Later the milk and broths 
stayed down. I continued carbolic acid in 
drop doses for three or four weeks, and 
she got entirely well, and I have seen her 
eat about anything she pleases. That was 
ten years ago, and she is in fine health to- 
day. Of course, it was a gastric ulcer, and 
the steady perseverence with the carbolic 
acid healed it. I was simply mistaken in 
my diagnosis, and didn't expect to cure her. 
My late father and myself went seven 
miles into the country to see a young man, 
whom the attending physician diagnosed as 
consolidation of the Jeft lung, following 
pneumonia. . He pronounced the case hope- 
less. We met the M. D. in consultation, 
and on examination found a pleural ab- 
iSceBS, which was evacuated by . thoracentesis, 
...the; patient dischargii^g- two wash-^anfuls 
-•. .«f' pust ;Draiinage wa? kept . .up for a , good 



while, and that man is in fine health and 
carrying on successful farming.' 

Two more cases of the same character: 
Twenty years ago I attended a young lady 
with a severe attack of pneumonia, and in 
time I discovered that instead of pneumonia 
she had pleuro-pneumonia, and it was suc- 
ceeded by a "suppurative pleuritis. One of 
the worst cases. I called Dr. R. O. Rob- 
erts, of Louisville, who astonished me by 
saying he thought by a certain line of treat- 
ment the case would recover. I told him if 
he didn't intend to operate, I would go to 
another surgeon. He then said if I insisted 
he would come over the next day and oper- 
ate. He came, and was surprised to find 
a washbowl of pus. I kept up drainage 
on the case for several weeks, and every 
morning I washed out the pleural cavity 
with a solution of permanganate of potash. 
She got entirely well, and to-day she is 
stenographer for the Kentucky Oil Co., at 
a salary of one hundred dollars a month. 

Another : The son of a prominent citizen 
was affected with suppurative pleuritis, and 
in due time, in spite of all my efforts to 
avert abscess, it ensued. I called a phy- 
sician, of the choice of the family, from 
Louisville. The mother of the boy was a 
graduate nurse before marriage, and I ex- 
plained to her the boy's condition, and in- 
formed her of the necessity of operative 
procedure to save his life. Naturally she 
dreaded the necessity. The doctor came, 
and before examining the patient I detailed 
the history of the case, and the therapy fol- 
lowed. He then examined him, and to my 
utter amazement stated to the family that 
he believed the inflammatory product could 
be absorbed away, and that they should 
take him to Palm Beach, Fla.. where he 
could be kept in the open air. When we 
returned to a private room I expressed my 
surprise that he should make such a rec- 
ommendation in case of a boy with hectic 
fever and pleural abscess. He replied that 
he didn't regard the case as having gone 
so far as to form an abscess, but it was 
rather a case, perhaps, of hepatization. 
This occurred at 9 o'clock A. M. In the 
evening I called to see the patient, and to 
ray surprise the mother was packing a 
, trunk for th? trip. Said I: "fs it possible 



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tlut you think that boy would live until 
yoit got hin\ to Florida? I tell you that he 
cannot be removed from here until I say so, 
unless you disregard my prognosis or dis- 
charge me from the case/' I told her to 
send her husband to my office. I told him 
wliat I had told his wife, and he said: 
**What you say goes." To be brief: I call- 
ed Dr. v., a Louisville surgeon, who opened 
tile cavity, and the result was a gallon of 
pas. The boy is now in splendid health. 
Jeffersonville, Ind. 



A PLEA FOR THOSOUGH SYSTEMATIC 

STUDY OF THE MATESIA MSDICA 

AND THERAPEUTICS. 

By Finley Ellingwood, M.D. 
BMtor of BllingfDOOd'B Therapeutio9. 

It is a generally accepted fact among 
those who pay any attention, to the devel- 
opment of the study of the curriculum de- 
manded of medical students, that there is 
altogether too great neglect, at the present 
time, of the study of materia medica, and 
that the study that is demanded is cursory, 
desultory and entirely devoid of attraction 
to the students. 

Physicians themselves, being asked to 
take an introspective view of their own 
knowledge of the materia medica, if they 
are honest, in the majority of the cases are 
overwhelmed with their own ignorance of 
the detail of specific or exact action of 
drugs. Many of them blame their alma 
mater, and those that should lead in medi- 
cal knowledge, for this ignorance; but I 
am inclined to think the individual himself 
is much to blame as well. 

The total profession has made marvelous 
advancement in the last three or four de- 
cades in the study of microscopy, bacteri- 
ology, pathology; in the development of 
bboratory methods of drug study, in the 
study of preventive medicine and of sur- 
fery, but in doing this the individual spent 
90 little time upon the all-important sub- 
ject of materia medica and therapeutics 
diat he actually in many particulars knows 
less of drug action to-day than he did 
thirty years ago. I say Uiis advisedly and 
fegretfully, bat the individual physician is 
mot as much a student of materia medica 



to-day as he was in the past, because the 
study then of materia medica was account- 
ed the most important branch. It was not 
overshadowed by surgery and the so-called 
scientific branches. To the physician dien, 
the all-important knowledge was to know 
what medicine to give to his patient when 
ill, that would cure. 

The study of this subject is difficult. It 
demands concentration; it demands persis- 
tency, and unless applied to the immediate 
needs of the patient — unless we can make 
immediate application of the knowledge ac- 
quired, it is startingly devoid of interest 
It is not exact, and every student delights 
in exactness. But why is it not exact? It 
is because our total knowledge of the sub- 
ject in the first place is imperfect; second- 
ly, the study is not conducted in systematic, 
precise, scientifiq lines. It is not properly 
classified or arranged; the study is not 
made, consistent with any exact principle of 
drug action. 

My object in writing this paper for the 
Medical Summary is to attract the atten- 
tion; of the readers to a renewed study of 
the action of drugs; to the study of drugs 
in line with a principle at once exact, ra- 
tional and attractive, and to encourage per- 
sistence in this study, in these lines, until 
the student shall have acquired a know- 
ledge and an experience, that in itself will 
stimulate him to a most enjoyable persis- 
tence in the study, and will enable him to 
say that there is in this study when cor- 
rectly conducted, a fascination that no 
other study possesses. 

I have been trying to teach for many 
years the following facts: The real reason 
disease is not cured is because we have not 
the knowledge of drug action necessary 
with which to cure it, or conversely that 
failure to cure disease is due to lack of 
knowledge ; 

That disease will ultimately be subdued, 
in whole or in part, by remedial measures ; 

That doubt concerning drug action is a 
deadly foe to therapeutic progress ; 

That the study of the clinical action of 
the single drug is the only true method of 
drug study ; 

That each drug acts directly and invar- 
iably upon one or more exact condittoos of 
disease, and, being so studied and knows* 



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•3 



an exact reliable knowledge of drug action 
is obtained; 

That when this knowledge is perfected 
we will not only prescribe for known con- 
ditions of disease with immediate success, 
but we can prescribe with equal success for 
conditions we have not previously met. 

We begin our study then with a systematic 
analytical study of each disease in order to 
determine those conditions which are in- 
volved, in the patient we are studying; at 
this time. 

We determine a knowledge of these con- 
ditions, and an ability to recognize them 
whenever we find them, in whatever dis- 
ease they may occur. We then determine 
what single remedy will always meet each 
one of those conditions and correct it 
Here is the whole thing in a nut-shell, and 
really this is all there is to it, as this in- 
cludes a thorough knowledge of the reme- 
dies, also with reference to their action 
upon exact conditions, as stated above. 

I trust each reader will read and re-read 
these statements until he has them clearly 
impressed upon his mind, and will weigh 
them fully with reference to his own meth- 
ods of studying the action of drugs, that 
he may compare the beauty of this method 
when completed with any other known 
method. 

It must be accepted at once that this is 
the only correct method of drug study. If 
we prescribe compounds because the man- 
ufacturer has advised them for certain con- 
ditions, we acquire no precise knowledge 
of the action of the constituents of that 
compound, and our prescribing is haphaz- 
ard, uncertain and largely guess-work. If 
we should by close study know the invari- 
able therapeutic properties of each one of 
the constituents of that compound, we are 
enabled to determine whether the total 
compound is applicable in tfie case required, 
or whether one or two of its constituents 
would not work even better, or whether it 
is not totally inapplicable. 

But if we understand drug action as 
above specified we will seldom, if ever, find 
an excuse for prescribing a compound, 
espectally one prepared for general condi- 
tions, but we wHl invariably find demands 
in the condition present in the patient we 
are prescribing for, for one, two or three 



single remedies, of which we feel confident, 
and will thus promptly make a perfect ad- 
justment to the case in hand. 

This is the course we adopt in every pa- 
tient, and this is the course we will adopt 
when we have learned our drugs, and 
studied specific conditions as above sug- 
gested, and when we adopt this course, the 
results obtained will be so satisfactory, the 
observations made will be so rational and 
consistent, and the confidence we will ac- 
quire in the knowledge we have so obtained 
will be so much in advance of any know- 
ledge previously acquired that the real fas- 
cination of this method will impress itself 
upon us, and in the future we will find our- 
selves willing students of the specific meth- 
od of drug application. 

Applying this method to the study of 
well-known drugs, every student is sur- 
prised at the amount of knowledge thus ob- 
tained, concerning the action of some very 
common remedies — ^knowledge of actions 
he had no idea could be present in that 
drug, materially broadening the field oi the 
drug an3 increasmg its value to the prc- 
scriber, in some cases a thousand-fold. 

Furthermore, those who have been de- 
veloping this method have made observa- 
tions of a great many drugs that are seldom 
mentioned by the principal medical jour- 
nals, or prescribed by the profession at 
large, and which are but little known, or 
are spoken disparagingly of by the Com- 
mittee on Pharmacy j^nd Chemistry of the 
A. M. A., but which possess values when 
studied in this line, actually superior to 
very many drugs, upon which volumes have 
been written, as standard drugs, and as 
those which could not be done without. 

Many of the readers of the Sumhaky 
have learned something in an empirical or 
a general way concerning the action of 
digitalis or aconite, strophanthus, or qui- 
nine, ergot, nux vomica, belladonna, ipecac, 
gelsemium, turpentine or jaborandi as com- 
mon remedies, but it is certain that study- 
ing these remedies from a specific stand- 
point, wc( have an entirely different study, 
and one which brings out beauties not be- 
fore anticipated. Added to this, every in- 
dividual should study from this standpoint 
Echinacea, baptisia, berberis, hamamelis, 
viburnum, mitchella, collinsonia, dioscorea. 



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colocynth, iris, chionanthus, podophyllum, 
sanguinaria, asclepias, sticta, euphrasia, lo- 
belia, apocynum, cactus, Crataegus, calibar- 
bcan, Pulsatilla, hyoscyamus, rhus tox, and 
perhaps one hundred and fifty others that 
I could mention, and he would be surprised 
beyond measure at the knowledge that 
would develop, and in the ability he would 
have in the knowledge acquired, to cope 
with disease in a satisfactory manner, far 
exceeding anything he had ever hoped or 
known. 

It is to encourage a study, as I have said, 
in these lines, of both the old and the new 
materia medica, that I am writing this 
paper. It is to disparage the common use 
of compounds and general pharmaceuticals, 
used with the hope only that they will cure 
the conditions for which they are prescrib- 
ed, when a knowledge of exact drug action 
will enable the prescriber to absolutely 
know, without doubt, what will cure his pa- 
tient; will make him able to cure the con- 
dition with positiveness and assurance, thus 
establishing the confidence of his patrons 
in his ability, first, and secondly, 'which is 
indeed most important, to establish their 
confidence in the fact that disease can be 
cured with the measures accessible to the 
physician. 

Ignorance of drug action, and doubt — 
therapeutic nihilism — has directly under- 
mined the confidence of the people, until 
the drugless methods of cure are now 
sought for and adopted by at least thirty 
per cent, of the population of the United 
States: until the surgeon is in demand 
only, to any great extent. Faith in these 
drugless methods cannot endure; they are 
auxiliary only. Let us at once re-establish 
the faith of the masses in correct drug 
action. 

While I thus urge this method upon the 
individual physician, this knowledge can- 
not be acquired at once; to become an ef- 
ficient prescriber one must be drilled in 
this study through a long period. I think 
it is necessary also that he forget much of 
the desultory knowledge, — ^many of the un- 
systemati<^, empirical facts he has previous- 
ly known. 

To have this method properly woven in 
with the web and woof of his total educa^ 
tion, it should be begun with his first dsty's 



teaching in college, and should be contin- 
ued with every day's instruction dttring the 
entire course. It is a deploraUe fact that 
so little materia medica and therapeutics is 
systematically, clinically, and thus practir 
cally taught in any of the colleges, and I 
fear there will not be much improvement 
in this course until the individual practi- 
tioner, and the profession as a body, per- 
sistently insist upon a more thorough teach- 
ing of this all-important branch. 

I would be gratified indeed, and I believe 
it would result in a most valuable discus- 
sion, if the reader of this paper would ex- 
press freely his own opinions on this matter 
through the pages of the Summary. All 
sides of the subject should be presented. 

32 North State St., 
Chicago, 111. 



THE BENEFITS AND EVILS OF HEALTH 
FADS. 

By Ernest F. Robinson, M.D. 

It can safely be stated that no health fad 
has been without its basic idea of truth. 
Many of them have contained far more 
truth than error, and the evil tiiey may 
have done has been less the fault of the 
fads than of the faddists. As is the case 
with religion, believers often go far beyond 
the teacher, and as the believer is seldom a 
thinker, harm is the result 

Diet ideas have formed the basis for al- 
most innumerable fads. To mention one 
now almost forgotten, probably few per- 
sons are aware of the origin of the term 
graham bread. It came from a fad started 
by a man named Graham, who taught that 
bread made from the entire grain of wheat, 
hulls and all, was a cure for all disease. 
The fad ran its course and has been for- 
gotten, but we still sometimes eat the bread, 
and we know that Graham was correct in 
the idea that, in some ways, flour made of 
the entire wheat grain is better than the 
so-called patent flour. 

Among the diet ideas of to-day the two 
most popular are vegetarianism and Flet- 
cherism. Some persons imagine these to 
be the same, which is far from Uie truth. 
The basic idea of Fletcherisin- ^may be 
stated as the art of getting. all; ^f .the «f- 



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ficienl) nutrition out of all the food eaten, 
be the kind what it will. To do this thor- 
ough mastication is a necessity. A second 
idea is that) the true, unpampered appetite 
is the best guide to the kind and amount 
of food which; is best for the individual. 
A Fletcherite may or may not be a vege- 
tarian, but he is fairly certain to be a small 
meat eater and to need far less food than 
is considered necessary by the average 
person. 

The vegetarian is opposed to the use of 
any animal food whatever. True, some 
use eggs and milk, but from a scientific 
viewpoint they cease to be vegetarians if 
they eat these. Some vegetarians go so 
far as to claim that fruit and nuts form 
the only perfect diet. Others claim that 
while all vegetable foods are good they 
must be eaten raw. The most valuable 
point which vegetarianism has taught us is 
tiie fact that it is not wise to eat so much 
meat as was once deemed a necessity. It 
is claimed that the practice of vegetarian- 
ism lessens the desire for alcoholic bever- 
ages. If this be true, it is certainly an- 
other strong point in favor. Vegetarian- 
ism has promoted the study of food values 
and educated many persons in this very es- 
sential class of ideas. 

The weak points of vegetarianism are 
the tendency to carry the fad to excess and 
the fact that the intelligent practice of it 
requires far more care and study than most 
persons are able to give to it This is true 
•even of faddists, and harm results. To 
practice vegetarianism to advantage one 
must be a good deal of a food expert. 
When intelligently followed, there is no 
question that this practice can be made an 
exceedingly good thing. At the same time, 
tiie opinion of by far the larger part of the 
medical profession is that strict vegetarian^ 
ism is not as wise as a properly balanced 
mixed diet. More than this, it requires less 
care and knowledge to properly balance a 
mixed diet than it does one composed whol* 
ly of vegetable foods. 

Fasting may be classed among the diet 
fads, in spite of the fact that it involves 
an absence of diet. This idea is a very old 
one. It has even been a part of the pracr 
tice of more than one religion. Nature 
herself often dictates it by the symptom 



known as loss of appetite. Animals fast 
almost absolutely when ill. The idea, then, 
is both natural and scientific If practiced 
as it should be, merely until a natural ap- 
petite is attained, it can do no harm and is 
reasonably certain to do good. Few fads 
have been carried to such foolish and even 
insane excesses as this one. There is 
nothing either natural or scientific about 
prolonged, unnecessary fasts, yet in some 
cases it has been necessary to stop them 
by legal measures. In others death has 
been the result. 

One of the present fads is the open-air 
fad. The success of this in the treatment 
of tuberculosis has done much to make it 
popular. As a treatment for this disease 
there is no longer any doubt of its value, 
but as a fad it is becoming a serious ques- 
tion whether it does more good than harm. 
While it does aid in the cure of consump- 
tion, when intellectually used, it is often 
used so unintelligently as to place patients 
in danger of pneumonia. It is well worth 
while to consider the fact that while the 
death rate from tuberculosis has been de- 
creasing, that from pneumonia has been on 
the increase. Pneumonia kills far more 
rapidly than tuberculosis, and it is folly to 
place a weak consumptive patient in dan- 
ger of the more fatal disease, in the mere 
hope of curin|^ the less fatal. Moreover, 
open-air living is only a small part of the 
proper treatment of tuberculosis. Absolute 
rest, proper nursing, medicines, and what 
may be called intelligent stuffing are even 
more important factors. Fresh air will not 
cure the consumptive who is improperly 
nourished and who must use up his energy 
in work faster than he can make it 

This open-air fad has done good by show- 
ing us that it is possible to cure consump- 
tion, and especially by setting in motion the 
social forces which will, in time, give us 
the power and money necessary to wipe out 
this disease, and probably pneumonia with 
it. Probably the harm that this fad does 
is a necessary factor to the spread of the 
knowledge it teaches. Doubtless this is 
true of all fads. Ideas, like men, must be 
made to work in order to prove their value. 
Fads are often scientific knowledge in the 
making. 

Bath fads are numerous and of various 



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degrees of usefulness and harm. The one 
best known is the cold bath idea. Carried 
to excess, this results in winter bathing 
through the ice and like idiotic ideas. There 
are constitutions strong enough to stand 
even this abuse, but if all persons were to 
tiy it, it would kill nine out of ten. The 
virtue of the cold bath lies in its tonic ef- 
fect, when it has one, which is not by any 
means always the case. It requires a con- 
stitution with more or less vigor to react 
properly to the stimulus of cold. With a 
weakened nervous and circulatory system, 
exactly the opposite effect is often die re- 
sult. Unfortunately nervous patients, the 
ones most likely to be harmed by such 
baths taken without intelligent supervision, 
are exactly the ones most likely to adopt 
them and to get harmful results. The idea 
that all persons can be hardened to cold 
bathing is sheer nonsense. All those who 
live may become hardened, but how of 
those who are killed in the process* 

Warm baths also have their uses, and 
the various degrees of heat can be made 
to accomplish many things when properly 
used. Water is simply the medium through 
which the required degree of heat is ap- 
plied. There are few treatments which re- 
quire a more scientific knowledge of cause 
and effect, in order to obtain results and 
prevent harm, than the use of baths. 

Physical culture, exercise, is so nearly a 
religion that it is almost heresy to criticise 
it For all this, as a fad, it does a vast deal 
of harm. In the young, where vitality is 
high, exercise is a necessity, but all that is 
needed is obtained in the form of play. 
Adults who do no work must exercise to 
retain good health. All men who work, as 
nature intended that all men should do, get 
all the exercise they need. Even where 
such work is largely brain-work it is a de- 
batable question whether physical exercise 
adds anything to the working output. It is 
certain that the amount of exercise taken 
by brain workers should be strictly limited, 
in order not to use up nerve force which 
could be better employed in mental effort. 
The truth of the matter is, that the part of 
the body a man should make strong is the 
part he must use in his daily life. Not 
only does he gain nothing by developing 
those parts which he can not and will not 
make regular use of, but he makes them 



a source of danger at some future time. 
A sane mind in a sane body is an excellent 
thing, but the most vigorous bodies do not 
contain the best brains by any means. One 
of the best things the physical culture fad 
has caused is the reduction of the use of 
alcohol, tobacco, tea and coffee. This is 
good work. The exercise itself^ in moder- 
ation and when used with intelligence, is 
certainly of service to many persons. Those 
who try to teach that it will prevent and 
cure all diseases are simply fools or fakers. 

The fad called New Thought is some 
thousands of years old. That suggestion, 
auto-suggestion, concentration, and the like, 
are of value is strictly true, and has been 
known for untold ages. That they will ac- 
complish every possible desire, if you only 
desire it hard enough — and this is practi- 
cally what is claimed — is unmitigated rot, 
and any one with an atom of sense, or even 
a sense of humor, ought to realize it. Some 
such "healers" even claim to be able to 
raise the dead. If we are to believe that 
sort of foolishness we might as well g« 
back to the days of witchcraft and be done 
with it. It is true that, up to a certain 
point, ''as a man thinketh in his heart, so 
he is." It is true that right thinking, like 
right living, will accomplish a vast amount 
of good. It is not true that right thinking, 
right living, or anything else we know of will 
accomplish everything. The worst of such 
claims is that they disgust intelligent people 
and prevent them from investigating and 
studying an interesting and useful subject. 

There are many other fads, past, present, 
and dottbtless to come, but we need not 
deal with them further. In general it may 
be said that it is seldom the use but most 
often the abuse of any fad which is danger- 
ous. The knowledge conveyed by fads is 
never new and is often exceedingly old. 
The factor which makes fads successful, 
and even necessary, is that trait of human 
nature which enables many of us to believe 
and practice as a fad, or a religion, many 
things which we would otherwise laugh at. 
Many fads are, indeed, religions. All of 
them are well worth careful study. The 
man who will get the good out of them is 
the man ho can study them in the light of 
reason, and accept the truth while rcjectsng 
the folly. 

Aubumdale, Mass. 



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CONSTRICTION, OBSTRUCTION AND RE- 
LAXATION IMPORTANT FACTORS 
IN DISEASE AND CURE. 

By G. Curson Young, M.D. 



''Those physicians generally become most 
eminent who soonest emancipate themselves 
from the tyranny of the schools of physic." 
—Rush. 

Xow, if we should be indulged in offering 
anything by way of advice, we would 
merely suggest that some might "pull the 
beam out of their own eye" before using 
such vigilance to discover the mote they so 
confidently expect to find in the eye of their 
brother. We believe the physician should 
not confine his views of medicine to any 
narrow routine or pathy; that he should 
not desire so much to see his own theory 
or policy prevail, as to succeed in curing 
his patients, and in order to accomplish this 
end we would suggest and try to impress 
upon the minds of some persons a few 
thoughts suggested by the attitude of some 
rut-bound men in the profession. 

Unimpaired health is that condition of 
the ysstem in which every organ naturally 
and regularly performs its duty, and that 
disease consists in inability of organs or 
parts to perform their duty or functions, 
physically and mentally; and that relaxa- 
tion and contractility are functions or 
properties of muscular fibre. 

Heat and moisture relax, and cold con- 
tracts muscular tissue, and all parts of the 
body respond. We know that cold will 
contract the blood vessels of the surface of 
the body, the extent of little or no evi- 
dence of blood vessels remain. The im- 
mersion of the part or parts so effected in 
warm water will so relax the vessel that 
they become unnaturally large, increased 
in size and capacity. 

If you should be so unfortunate as to 
pierce your hand or any part of the body 
with a splinter of wood or any foreign 
body, and suffer it to remain in the tissue 
a while, inflammation followed by suppura- 
tion, and obstruction will be the phenomena. 
and in proportion to the inflammation so 
will be the obstruction regardless of the 
original cause. This is a natural process, 
and obstruction to blood circulation means 



death to the part, and possibly the whole 
body. The logical action to take would 
be to remove the cause before suppuration 
sets in, and thus prevent such inevitable re- 
sults. 

All abnormal growths and developments 
are caused by some arterial or venous ob- 
struction, just as in a leaf on any tree. 
Boils, pimples or any other eruption are un- 
doubtedly due to obstruction and irritation, 
just as the splinter irritated the part it 
entered and remained there a few hours. 
If the splinter is removed, except in some 
cases of very severe injury, the inflamma- 
tion, suppuration, and pain will cease and 
the wound will heal. The first thing to do 
then is to remove the offending cause. 

Suppose morbid matter, or a bruise, or a 
collapse of blood vessels by cold, cause an 
obstruction in the ligament or capsule of a 
joint, it is evident that any treatment which 
will remove the obstruction to the circula- 
tion will prevent miTch pain and distress, 
which otherwise would continue for a long 
time. This principle is effective with a 
felon or a carbuncle, by soaking the finger 
or affected part in hot water; if on the neck, 
use hot packs for* an hour or more fre- 
quently. Sometimes a stimulant as well as 
a relaxant is called for, then use the hot 
and cold packs, alternating them. This 
may seem simple, and something like the 
old grandmother's treatment, but it is the 
best, because it removes the clogged, con- 
gested obstruction which is the cause. In- 
flammation always subsides when life's ob- 
structions are removed, as certain as day 
follows night. 

We must not overlook the fact that it 
makes no difference whether an obstruc- 
tion occurs in the toe or finger; fever never 
occurs internally without an obstruction, 
and whether of the lungs, liver, bowels or 
brain, inflammation and fever are simply 
accumulated vital action symptomatic of 
disease, which always exists as an antece- 
dent and an indispensable forerunner of 
what we call disease. 

A short while ago a woman, aged 71, 
came to consult me in relation to a car- 
buncle on the back of her neck. She had 
been visiting, a number of weeks in Newark, 
N. J., and while there two carbuncles came 
on her neck, and she was under treatment 



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by a physician for six weeks. About two 
weeks after she returned home the third 
one appeared on the left side of her neck, 
which was the cause of her coming to see 
me. Three days after the commencement 
of treatment, a fourth one commenced de- 
velopment, just above the ear on the same 
side. This last one was attended to, and 
two days later the fifth and last one ap- 
peared on the labia niajora of the right 
hand side. All of these formed in a few 
hours, one after the other, within the com- 
pass of a week. All were treated alike 
with hot packs continuously, and internally 
with specific echinacea, dose ten drops four 
times a day, and tablets calcium sulphide, 
half grain, one morning, noon and evening. 
All three of these carbuncles were arrested 
in their development, healed, and the pa- 
tient discharged in thirteen days. The base 
of the least one was as large as a walnut. 
In this case we have a convincing example 
of results when obstructions are removed, 
inflammation subdued, and suppuration ar- 
rested. 

Internal inflammation is not always caus- 
ed by morbid matter. It may be caused by 
engorgement. We must not lose sight of 
the fact that relaxation and contractility 
are the functions of muscular fibre, and 
that the blood vessels of the surface of the 
body may contract to one-fourth their nor- 
mal size, and hence a person when "taking 
a bad cold" may have twice or four times 
the usual quantity of blood thrown on some 
internal organ; but in the nerves of the 
part affected, pain and contraction result 
in a binding and engorgement of the part, 
when we may have all the horrors of pneu- 
monia as the result 

We observe that a relaxation of the 
strictured blood vessels and a resupply of 
blood to them will relieve the internal ves- 
sels of the engorgement, and thus cure the 
patient at once in a case which would prove 
fatal by delay of treatment, or by a treat- 
ment which failed to accomplish the pur- 
pose indicated. 

When a thorn, a piece of wood, or any 
other foreign substance enters, and remains 
in the flesh of the body, no one waits until 
unaided nature effects its expulsion, but 
they extract it as soon as possible, and in 
like manner if an obstruction should occur 



in the lungs or any vital organ, it is most 
certainly followed by suppuration or morti- 
fication, if the inflammation and fever 
should fail in the removal of the diseased 
condition; and yet some people will wait 
imtil engorgement breaks down the deli- 
cate tissue of an organ, and death is inevit- 
able, before they consult a physician, sim- 
ply because of their lack of confidence in 
the medical profession. And this will con- 
tinue so long as the profession disregards 
the plain truth which true science incul- 
cates. The fact is, many medical men seem 
to give little or no attention to the princi- 
ples which should be the guide of every 
physician in the treatment of disease, or 
they would not harp on the vaccine and 
serum theory, in fevers, inflammation or 
auto-toxic conditions. Why, the most stupid 
mechanic would be ashamed to be seen tug- 
ging and worrying himself to stretch a 
wagon tire to its place on the wheel when 
cold, and yet puUies and all the various 
"adjusters" by which one may tear another 
in twain for the resetting and adjusting of 
displaced bones are just as incotisistent as 
would be the conduct of a smith who, over- 
looking the fact that heat relaxes iron, 
undertakes to get the tires to their place 
in a cold rigid condition. A number of 
surgeons have learned and acted on the 
light of these natural laws, but it remains 
to be known that the principle is capable 
of general application by the physician. 

We think that many lives might be saved 
when the medical profession have learned 
that typhoid fever and other malignant 
forms of disease, may be very often thrown 
ofif in their forming stage by a prompt 
treatment. What does the small wiry pulse, 
headache, and general soreness or pain in- 
dicate? A collapsed, strictured, obstructed 
condition of the arterial and venous system. 
We must see that if a relaxation of the 
blood vessels to their natural size should 
be speedily accomplished, that the danger- 
ous condition is removed, and suppuration 
prevented. A suppurative condition of the 
glands of Peyer of the bowels will not oc- 
cur if the blood is brought to its natural 
channels, and a complete relaxation of af- 
fected parts remove obstructing matter. 
Warm baths, drinking freely of warm 
water, wet sheet packs, hot vapor baths. 



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and intemal diaphoretic medicine will tend 
to relax the system and free it from the 
£^p of unnatural stricture. It is a stub- 
bom case, and rather ' dangerous to stand 
by and see nature and disease decide the 
contest, and nature not win, when the prop- 
er aid is given. We mean by relaxation 
such a condition as heat, warm bath, warm 
pack, soaking the feet, or a dose of lobelia 
-Will effect, and not a prostration, such as a 
narcotic or blow on the head with a club 
would produce. Any case of obstinate ob- 
struction that the vapor bath and lobelia 
-will not relax is almost hopeless. When 
vapor baths and hot bathing are inefficient, 
when pleurisy, pneumonia, asthma, croup, 
typhoid fever, or inflammation of any or- 
gan, are racking the frame with excruciat- 
ing pain or threatening strangulation, who 
would not gjve lobelia? 
Washington, N. J. 



PERinCKMJS VOMITING OF PKEGNANCY, 
AND A GHOST STORY. 

By a. Rose, M.D. 

The literature of vomiting of pregnancy 
is very voluminous. This was again dem- 
onstrated by Dr. C. B. Ingraham, of Den- 
ver, who read, at the last session of the 
American Medical Association, in June, 
191 1, a lengthy paper on the subject and 
quoted sixty-three publications. But neither 
he nor any of those who took part in the 
discussion mentioned the most rational, the 
physiological remedy in cases of reflex 
vomiting of pregnancy of which I have 
spoken repeatedly in different journals, and 
especially in my book, "Carbonic Acid in 
Medicine." I published my observations in 
the year 1884, and Adrian Schiicking his 
experience with the same remedy in the 
year 1885. 

This remedy is carbonic acid gas douches 
applied into the vagina or into the rectum 
by means of a gas generator which I have 
introduced. The anesthetizing effect of the 
gas will as I, and, independent from me, 
Schucking have demonstrated, arrest reflex 
vomiting. It is possible that the curative 
effect of carbonic acid in vomitus gravi- 
darum has been known before Schiicking 
and myself made use of it, but no refer- 



ence of this kind is found in Schiicking's 
paper, nor have I found it mentioned in 
literature. And this remedy is simple and 
it is harmless, but there exists a ghost story 
on account of which it is not accepted, on 
account of which it is not even spoken of. 
I may be permitted to quote from my book 
mentioned something about this ghost story. 
Early in the year 1884 I was called to a 
neighboring city as a consulting physician 
in a case of incessant vomiting of preg- 
nancy. All the usual remedies had been 
tried in vain. I suggested the application 
of carbonic acid gas douche to the os — this 
being a case of reflex vomiting originating 
in uterine neurosis, but my suggestion was 
not accepted. It happened that my col- 
league, a great, well read gynecologist, be- 
lieved in Scanzoni's night-mare of contrac- 
tions of the uterus and the danger of abor- 
tion if carbonic acid gas was employed. 
The error of Scanzoni has been exposed 
by many physiologists, by gynecologists ; it 
has been demonstrated over and over again 
that carbonic acid introduced either into 
the vagina or into the rectimi will aever 
cause uterine contraction, will never pro- 
duce abortion, how often or how long you 
may try. I myself have had a case in 
which a pregnant woman in consequence 
of a misunderstanding made daily carbonic 
acid gas douches every day during the first 
three months of pregnancy without any un- 
pleasant effect to herself or the embryo,, 
without interruption of the pregnancy. In 
the book quoted I have given the history of 
Scanzoni's error and spoken of as experi- 
ments made on pregnant animals to prove 
that Scanzoni was mistaken. Scanzoni is 
dead, but his error haunts us yet. It seems 
impossible to bring it out of the heads of 
some physicians that carbonic acid is not 
a means to produce abortion. While car- 
bonic acid gas douches do not cause uterine 
contractions they are, besides arresting 
vomiting of pregnancy, an excellent rem- 
edy in case of scanty menstruation or 
amenorrhoea. 

173 Lexington Ave., New York. 



Powdered potassium nitrate rubbed on* 
the face twice a day, after being sprinkled 
on a damp cloth, will sometimes effectually 
remove fgreckles. 



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TREATMENT OF APPENDICITIS. 



When a diagnosis of appendicitis i . made, 
and it \s not clearly a case of ncurrsis with 
pu-^ formation, treatment as follows should 
be instituted at once. 

Put the patient to bed. Make a solution 
•of 8 ounces h'.psoni salt>, i dram carbolic 
acid in 4 quarts of hot water. Fold two 
flannel pads several thicknesses, and large 
enough to cover the abdomen, or about 
9x16 inches for an adult, and apply hot 
packs from this solution, using care not to 
burn the skin, and changing every five to 
eight minutes, for an hour at a time, and 
use every alternate hour. Internally, give 
a heaped teaspoouful of a saline laxative in 
a glass about two-thinU full of warm water 
every two hours until bowels move freely. 
A teaspoonful of Epsom salts can be 
added to the blue paper of a seidlitz 
powder, and the powder taken in the usual 
way, and they repeated to effect. Of course, 
there is no objection to giving the clear 
Epsom salts if the patient is willing to take 
it tiiat way; dissolve it in a smaller quan- 
tity of water and follow it with a glass of 
clear water. 

Give 1/4 grain calcium sulphide every two 
hours. Prepare tumbler medicine my dis- 
solving about 1/4 ounce potassium citrate, 
24 drops tincture aconite, 24 drops tincture 
belladonna, in 24 teaspoonfuls water, and 
give a teaspoonful every hour to effect; as 
conditions approach the normal, doses may 
be put farther apart. 

The diet must be light in quality and 
quantity. 

The therapeutics of the foregoing treat- 
ment is to equalize circulationu, relieving 
congestion, eliminate any cause for toxe- 
mia, antagonize the breaking down of tissue 
and puss formation, and to assist nature to 
restore the parts to normal. 

But if proper treatment be given, and the 
temperature and pulse do not materially di- 




minish in their proper ratio within twenty- 
four hours, a diagnosis of pus can be pretty 
safely made, and the case considered surgi- 
cal. This docs not mean that there is no 
hope for the case unless operated upon, as 
adhesions may form, walling off the pus 
into pockets where it may absorb or be- 
come caseous; but it means that surgery 
would be the best and most scientific 
method of treatment. — Dr, . A, Button, in 
Therapeutic Record. 



INJECTION FOR GONORRHEA; NEURO- 
TONIC, ALTERATIVE. 



The following are a few select fornuilas, 
not all original with me, but thorou^^hly 
tested, and known to give satisfactory re- 
sults, generally when indicated: 

INJECTION FOR GONORRHEA. 

1^ Sol. bismuth et hvdrastis (Mer- 

rcll) : 3J 

Aqua ^\\' 

Zinc sulphate gr iv 

M. Sig. — Inject every time after urinat- 
ing. 

SHEEP ANCHOR TONIC. 

]^ Quinine sulphate gr. xxx 

Tinct. gentian comp ^M 

Strychnine sulph gr j 

Syrup hydriodic acid 5u 

M. Sig. — One teaspoonful in water three 
times a day. 

NEl'RO-TONIC, ALTERATIVE. 

I^ Syr. hydriodic acid 5u 

Liq. potass, arsenitis 5ij 

Tine, calumba 5j 

Tinct. capsicum 3i 

Syr. hypophosphites comp., 

q.s. ad. 3yj 
Sig. — Teaspoonful in water three times a 
day. 



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21 



NEOFORMANS VACCINE IN CANCER. 

Dr. Alfred Potter, of Brooklyn, N. Y., 
reports his success in the treatment of in- 
operable cances cases at the King's County 
Hospital, by means of the neoformans vac- 
cine. The Micrococcus neoformans has 
been isolated from cancers, and if not the 
cause of cancer, it is at least generally 
found in association with cancer. The au- 
thor treated twelve inoperable cases with a 
vaccine prepared from this organism. Three 
cases which were cachetic were not helped. 
In the others, improvement followed one or 
two injections of from 5 to 200 million bac- 
teria. Relief of pain was immediate; the 
general health improved; ulcerations be- 
came cleaner; healthy granulations formed; 
and the disease seemed to be checked. In 
cancer of the uterus, the malodorous dis- 
charge was diminished, and bleeding was 
stopped. — Medical Record. 



THE MODERN TR£ND OF PSYCHIATRY. 

Dr. J. V. May, of Fishkill-on-Hud^on, N. 
Y., in the Interstate Medical Journal, re- 
views the progress that has been made in 
recent years in our study of psycliic dis- 
eases. The work is only beginning to yield 
results, thanks to such men as Kracpclin, 
Nissl, Alzheimer, and many others. Special 
attention is given to the "psychic trauma" 
of Freud, with the sex problem, dream in- 
terpretation and psycho-analysis. May be- 
lieves that the outlook for psychiatry is ex- 
ceedingly hopeful. 



IPECAC TO ABORT TYPHOID FEVER. 



Dr. William L. Frazier, of Mountain 
Home, Idaho, presents the histories of six 
cases of typhoid fever in which he made 
use of ipecac to abort the disease. The 
drug was given in capsules coated with 
salol to prevent their dissolving in the 
stomach and causing vomiting. The ipecac 
was given for six successive days, begin- 
ning with 30 grains, and decreasing 5 
grains each day until the dose was 10 
grains. The author believes that the dis- 
ease was aborted by means of this treat- 
ment. — Medical Record. 



NITROUS OXIDE GAS AND OXYGEN 
ANESTHESU. 

Dr. Clifford U. Collins, of Peoria, 111., 
read a paper on this subject. The advan- 
tages of nitrous oxide gas and oxygen, as. 
pointed cut by him, were: 

1. So far no one had been able to discov- 
er that it had any harmful action on any 
tissues of the body when administered in 
anesthetic quantities. 

2. It had no odor, and the patient was 
not aware, so far as any odor was concern- 
ed, that he was taking an anesthetic. 

3. It produced no shock of itself, and the 
total amount of shock from an operation 
was much less under gas and oxygen than 
under ether. 

4. It did not have any harmful action on 
the leucocytes, therefpre its use was indi- 
cated in infections. 

5. Its danger was not increased by fre- 
quent sub-sequent administrations 

6. There was much less post-operative 
vomiting than from ether or chloroform. 

The disadvantages were : 

1. It was considerably more expensive 
than ether or chloroform. 

2. It did not produce deep relaxation of 
tlie muscles. 

3. The anesthej^ia was lighter and more 
transient. 

4. It required a more expen:?ive adminis- 
tration apparatus. 

The di.^advantages of gas and oxygen 
concerned the anesthetist, but did not add 
any discomfort or danger to the patient. 
With an apparatus like the Teter, nitrous 
oxide gas, oxygen or ether might be ad- ^ 
ministered separately or in any desired "^ 
combination. In this way the anesthetics 
might be fitted to the patients and not the 
patients to one anesthetic. — Lancet-Clinic^ 



THE MUSTARD PLASTER. 

Its uses are many, but too often it is 
spoiled in the making. Do not use boiling 
water in preparing the paste. Heat de- 
stroys the essential oil upon which the vir~ 
tue of the mustard depends. 



The best evidence that a child has worms 
is to see them in the stool. Symptoms are 
unreliable. 



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*a)IVIDING THE PEE." 

Editor Medical Summary: 

In reply to the article under the above 
caption, appearing on page 327 of the Jan- 
uary Summary, I wish to say that as a rule 
1 believe that the country doctor is as hon- 
est as any other class of men, but just the 
same there are the dishonest among: them 
as well as other classes of men. T have 
had the experience of the physician ped- 
dling his case, and I do not doubt that other 
men have had the same experience. But 
all this does not settle the dividing of the 
fee. It should be looked at on another 
l)asis. 

The trouble with physicians is th^t they 
do not teach their patients to expect to pay 
their physician for their services. The 
quicker we physicians realize this principle 
in the practice of medicine the better off 
^e will all be, the greater will be the re- 
spect of the public for us, the more just 
will be our income. The layman of to-day 
thinks that the advice of the physician is 
nothing but spending a little time, and f ree- 
Jv say that a physician has no investment. 
Make your patient know the proper facts 
and realize that he is getting something 
that he must pay for because it is worth it. 
AVe do not loiow the value of an article 
mintil we have paid for it. 

The country physician can not afford to 
take a patient to the city with the impres- 
sion that it is not costing the patient some- 
thing for his time. At other times he will 
expect you to do equal service without cost 
to him, and you will not have the specialist 
to divide his fee. 

In the town where my father practiced, 
prior to his time, there had been a physi- 
cian who took whatever his patients had 
to give as the old-time preacher. When 
this physician came to die the township had 

23 



to bury him. It took my father some time 
to teach these people that they had to pay 
the physician, but it was his only salvation. 
They learned to do so, and I believe that 
they had more respect for my father than 
they did for his predecessor. 

I believe that the best way for the physi- 
cian is to be frank and honest with his 
patients, and not take so much stock in the 
necessity of physic influence as is often 
common as an excuse to deceive his pa- 
tients. The patient finds out these little 
deceits and loses his confidence in you. 
Learn the patient to pay for what he re- 
ceives and charge him a reasonable fee, 
and expect him to pay for it. Then you 
will be. respected and thought more of by 
your following. If you give the impression 
to your patients that you are taking him to 
the specialist without fee, he considers you 
cheap and believes that your service in 
other ways is of equal value, and you will 
have trouble making a living. This is the 
great trouble with physicians to-day. They 
do not lead the layman to know the value 
of their services. 

RoLLiN H. Barnes, M.D., 
Editor of The Proctologist, 

Metropolitan Bldg., St. Louis, Mo. 



IfALARIA: ITS TREATMENT. 

Editor Medical Summary: 

Either remittent or intermittent malaria 
is more or less puzzling to the practitioner 
of medicine, especially the malignant forms, 
but we are very often confused in making 
a diagnosis in the developing forms of the 
disease, as they assume almost any other 
condition or train of symptoms in any dis- 
ease; indigestion, rheumatism and hepatic 
congestion more frequently than any other ; 
and when a young M. D. becomes puzzled 
over a case enough to get down his books. 



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look out ! Somebody is going to die. Qui- 
nine indiscriminately used does as much 
damage as it is capable of doing good. I 
have learned a great deal about both re- 
mittent and intermittent malaria in an ex- 
perience of fifteen years. I used to think I 
was "it" in the treatment of this dikase, 
but after losing an occasional patient, I 
learned better. 

When called to see a patient suffering 
from this disease, the cardinal thing to do 
is to give relief speedily. High fever must 
be combatted, pain relieved, vomiting stop- 
ped, and proceed to establish the secretions 
as early as possible. All of the sedatives 
are valuable, antipyretics are admissable in 
high fevers, the liver and kidneys must 
have early and prompt attention, and when 
a tendency to normal secretion is estab- 
lished, the malarial poison itself must be 
antidoted. 

Calomel and podophyllin are excellent, 
the system must be unloaded of toxic mat- 
ter as well as malarial poison, and when 
the above is followed with hot castor oil or 
solution of phosphate of sodium the tem- 
perature subsides mildly, and the kidneys 
assume a normal function, the tongue be- 
gins to clean, and right here the treatment 
begins. 

Now I wish to give the readers of the 
Medical Summary a remedy that will do 
the work, and without taxing the resources 
of the nurse and patient or physician. I 
have never since using this formula known 
it to fail in either forms, remittent or inter- 
mittent : 

5^ Cinchonidine sulph., 

Ammonium muriate aa 5j 

Tr. iodine comp., 

Sol. potass, arsenitis aa 5iv 

Tr. capsicum 5ij. 

Elix. simplex q.s. Jviij 

M. Sig. — One teaspoon ful at 6 and lo 
A. M., and 2 and 6 P. M. each day, and in- 
crease to two teaspoonfuls after the first 
four days. Shake well. 

Of course, a light but highly nutritious 
diet must be encouraged, and the above 
treatment enhanced by every possible aux- 
iliary, but bear in mind it is the very best, 
and really par excellent for the malarial 
poison. A. J. Mann, M.D. 

Alvaton, Ga. 



AN UNUSUAL CASE. 

Editor Medical Summary: 

A case of obstetrics. — Mrs. H., aged 23 
years, whose pregnancy went on unevent- 
fully to full term. I was called at 10 o'clock 
A. M. on December 27th last, and on ex- 
amination found very slight dilatation, with 
soft OS, and head presentation. My ser- 
vices not then needed, I left her in the 
hands of a trained nurse, with instructions 
to summon me when labor pains set in. At 
2 P. M. I was called, and found her in first 
stage, and very nervous and uncomfortable, 
feeling an unusual sense of exhaustion and 
helplessness. It was her second accouch- 
ment, and the first labor was natural and 
of short duration. A short time after I got 
to her she said she must get up on the com- 
mode. I stood back, and hearing such an 
excessive flow, I remarked to her, and the 
nurse, that such a gushing could not pos- 
sibly be from the bladder; and suddenly 
she became deathly pale, and would have 
fainted had I not put her back in bed, with 
her head lower than her body. It was evi- 
dently a separation of a large part of the 
placenta, uncovering the blood vessels. I 
pushed the labor through, by manual dita- 
tation, and in an hour and a half after she 
gave birth to a seven-pound girl, but it was 
followed immediately by such an immense 
flow of bloody serum that it ran out of the 
bed on the floor to the amount of two gal- 
lons. The amnion seemed to discharge 
about a normal amount, just preceding the 
delivery. The unusual amount of fluid was 
colored by the blood which was in the 
uterus before the second stage of labor was 
reached. As soon as the child was bom, I 
gave the second dose of ergotole hypoder- 
mically, and detaching the child, found it 
colorless, inanimate — a case of suspended 
animation as a consequence of the circula- 
tion having been, perhaps, entirely cut off 
from the placenta, because it was largely 
detached from the womb. The nurse and I 
hurried to the bath-room, and swathed it 
with towels wrung out of hot water; tried 
the same procedure used in a case of 
drowning; inflated the lungs myself several 
times ; rolled it, took it by the feet, swing- 
ing with head down; and after ten min- 
utes' hard work the red color came to the 



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THE MEDICAL SUMMARY 



skin, its eyes opened, and a few minutes 
after it got a good breath, and cried. The 
mother was then delivered of the placenta, 
and grasping the womb with cold towel 
folded over the same, I got firm contrac- 
tions. However, after every contraction, 
and the womb relaxed, a hemorrhage fol- 
lowed. A cold compress and bandage was 
kept on, and hot douche given at intervals. 
The hemorrhages continued more or less 
for two days, although she got regular 
doses of ergotole and deodorized tincture 
of opium. She never had any rigors nor 
fever, and her milk came without the slight- 
est disturbance. She went on to a splendid 
recoTery, and has plenty of milk, for a 
promising and healthy looking girl. Losing 
so much blood brought the lactation on 
without inconvenience. I have had post- 
partums, but such fearful antipartums I 
think must be unusual. If she had had any 
bleeding during her gestation, i. e., evi- 
dences of placenta pra^via, I would not 
have been surprised, but she had never had 
an untoward symptom until this great gush 
of blood came just at the beginning of 
labor. She lives in a large house, and went 
up and down stairs frequently just before 
the time for her accouchment, and fre- 
quently lifted her heavy boy, carrying him 
upstairs. Some such strain caused the par- 
tially detached placenta, and nearly cost 
her and her infant girl their lives. 

Teffersonville, Ind. D. L. Field, M.D. 



CIGARETTES IN INDIANA. 



Editor Medical Summary: 

In the December Summary, 191 i, you 
speak of Indiana having an "anti-cijj:arotte 
law." Well, we did have such a law, and 
a few men were fined for smokinjx, and a 
few more for selling the devilish things, 
but I think the law has been repealed; if 
not it is the most violated law you ever 
heard tell of, as I think, at a conservative 
estimate, there are ten thousand cigarettes 
a day smoked in this city alone. It seems 
that cigarette fiends and saloonkeepers take 
a peculiar delight in breaking the law in 
this State, and I suppose the same condi- 
tion exists elsewhere. 

O. B. Surface, M.D. 

Indianapolis, Ind. 



KUS ES SALAHIM.— A WONDERFUL 
REMEDY. 

Editor Medical Summary: 

Translated from Arabian it means : "Tea 
of Salahim." This tea comes from a shrub 
belonging to the family of the celastraceaes, 
and is used in Arabia, Abyssinia and North 
Africa as a tonic, twigs as well as leaves. 

I don't know whether to call it fortunate 
or not, that in this country one does not 
know much about it, for it is a most power- 
ful abortefacient and is largely used as such 
by the Bedouins (Xomads). 

But every dark cloud has a silver lining, 
and so it might be good to acquaint our- 
selves with the positive virtues of this tea. 
It has the looks and about the taste of 
cocoa, and in overdoses produces inebriety. 

The first acquaintance with kus I made 
in 1885 on my visit to a Bedouin camp in 
North Africa. When aboard of our man- 
of-war I met with Ali Ben Mohammed-el- 
Mokaddcm, son of the shcick of Beni Ha^- 
san-el-Kairowin. He invited me to the 
camp of his tribe, and after a camel-ride 
of ten hours through the desert I arrived 
there safe, but not sound, for my pnster- 
icTcs hurt like the proverbial "dickens." 

Ali ordered at once a cup of kus es sala- 
him for me. I never for.c^et the immense 
relief of my weariness after drinking a cup 
of the beveraj:^c. ITuwevcr, woe to the 
man who indulges in it ; woe to him who 
becomes its slave, just like so many abori- 
gimies are. For althou,![,di it acts promptly 
and etficiently it is worse than cocaine if a 
habit is acquired, even worse than hashish 
(Indian hemp). 

In 1897, visiting a hospital at Djeddah, 
in Arabia, I witnessed its administration in 
a case of complete uterine inertia, a French 
doctor attending. It worked like a charm, 
and in retarded labor it makes the forcep.s 
unnecessary nine out of ten times. My 
French colleague told me how it gained 
ground in Europe for the treatment of mi- 
graine and some nervous disorders, in slow 
births, and alas, also in amenorrhea due to 
pregnancy. 

Said he: 'W oublies pas docteur, que 
c' est une epee a deux tranchants." (Don't 
forget, doctor, that it is a two-edged sword.) 
Meaning by this, that in the hands of un- 



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THE MEDICAL SUMMARY 



25 



scrupulous doctors it could be used for the 
purpose of crime. 

In m^^ obstetrical practice it has proved 
to be a boon and has given lots of com- 
fort to the becoming mothers as well as to 
my work. It has asolutely no bad after 
effects, does not hurt the offspring or the 
mother, and does not produce hemorrhage. 

D. ZwitiT-MAX, M.D. 

Xiles, Mich. 



PRACTICAL NOTZS AND REPLIES. 



Hditor Medical Summary: 

In re to Dr. Lecan's article, page 326, 
January Summary, that the Stale provide 
for microscopical examination^, etc. the 
Connecticut statute^ provide lliis through 
its State IJoard of Health: 1' laminations 
and analysis of disease specinien>; milk 
and water are made free for a!i\ physician, 
if such a recpiest c<.mes from the town 
health officer. The la>t legi-latiire appro- 
priated $8000 for free autito <in and other 
serums. This is supi)lied on ai)i,ticati<>n lo 
the local health oincer and t!ic ^'.riini u]j- 
plied by local pharmacists, will, il.c nnder- 
standing that when such rcqui>iiirn is ni.i-le 
it constitutes prima facia e\ idcni c, or at 
least .sufficiently so, to establish quaraiuiiie. 
Probably this method is open to some ob- 
jection, but on the whole this new arrange- 
ment ib beneficial to many poor people, 
who would otherwise have to do without. 

Dr. Lycan's experience no dciiht corre- 
sponds with that of many other prartiti( n- 
ers, and his warning is timely and ]>rai-tical. 

Dr. Bott's article (page 332) (>n opnnn 
and its uses in post-partum licniorrliagc 
contains some good ]3oints. In my experi- 
ence a:r( pine ret- better without the mor- 
phine, but the a'hiiti *n of niln -L^'ycerin or 
strychnine aids tiie action of the atropine, 
uterine contracti(;n being stren;:tliened by 
strychnine, while morphine rcuirds or re- 
laxes. Many physicians decry the use of 
opium or morphme for any di-ease, but 1 
believe that very few practice medicine 
without its use. 

On page 339 appears an extract from an 
article on pneumonitis, by Dr. Robert L. 
Hammond. The treatment outlined is cer- 
tainly unique and one which in my opinion 
will not be adopted by many, being imprac- 



ticable and of questionable value compared 
with other well-tried and reasonably suc- 
cessful measures. I prefer Dr. Eason's 
method (page 345) with slighc modifica- 
tion. When the mortality from this disease 
is so much below the average with my pres- 
ent mode of treatment, 1 am loath to change 
lor any new (or old) method, no matter 
by whom such is proposed, and I am not a 
believer in routine or stereotyped treat- 
ments, either. 

I admire Dr. Brady's critiusm i page 349) 
which is frank and pointed. 

LoL'is J. p. Ns, M.D. 

Koxbury, Conn. 



A GOOD SUBSTITUTE FOR CIRCUMCISION. 

li'litor Medical Summary: 

Instead of circumsising a person, and 
thereby depriving him of a ring of his 
integument, and opening an avenn: /or in- 
fection, you will be astonished ai the case 
that a seeming resistant picpiue will be- 
come dilated through constant c:cntle [ires- 
sure. The instrument iM-d for that pur- 
p'iSe is'of bone, two inches Idr.ii. composed 
of two curved parts that are hin;:;ed in the 
middle at their convex sides (like the i)ring 
clothes pin) : the thicknes.^ (.1 btnli hU.des 
when coajiti'd are about 3^ i(> of :.n inch in 
(Hameter. J'his is introduced unocr the 
prepuce, a thin rubber baud i- :'>i..ie(l to 
the handles. As the rubber eoniract^, tlie 
front (>f the forceps expand: tliis is w(jrn 
for twenty-four hours, or jntil luli dilation 
is pHjduced. Once dilated the fi^reskin re- 
mains so. This operation is financially 
against me, as I used to gel from ten to 
twenty dollars for a circunici'-i" n. wiiich I 
cannot now do conscientiousU . 

R. D. Faiklx. M.D. 

iiio S. Rampart St., New Orleans, La. 



Chronic ulcers of the face situated in the 
area between lines drawn from the outer 
end of the eyebrow and the upper border 
of the ear above, and the angle of the 
mouth and the lobe of the ear below, are 
usually epitheliomata of the basal-celled 
variety, and they are comparatively non- 
malignant. 



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SOME OBSERVATIONS ON TYPHOID. 

Editor Medical Summary : 

The writer has, during the past twenty- 
five years, made some special observations 
on typhoid, and has almost come to the 
conclusion that the disease is inclined to 
"run in families." I will cite one family 
in particular. The first case was a daughter, 
about IS years old, who had a typhoid at- 
tack which lasted six or seven weeks. The 
next case was an older married sister living 
about a mile and a half from the old home, 
who was sick some six or eight weeks. 
This was a year after the first case, and 
as the other was in autumn. The next fall 
two brothers had the disease, but were not 
living at the old home any longer, having 
moved to a small village. These cases were 
very severe, lasting some ten or eleven 
weeks each. One of them, I told the fam- 
ily one day, could not live through the day. 
The next fall another younger daughter 
took the disease and was worse than any 
of the others, being in bed thirteen weeks, 
and this was at another place, they having 
moved again. 

These five persons, brothers and sisters, 
all had the disease in four years, and all in 
different houses, except the two boys, and 
to the best of my knowledge there were not 
more than four or five other cases of the 
disease in a radius of three miles during 
these years. 

The paternal grandparents of the five pa- 
tients I named above died from typhoid 
fever a number of years before any of 
these patients were bom. 

Another rather peculiar circumstance in 
this connection is the fact that the writer 
with his family of wife and four children, 
was living on a lot that was at least ten 
feet lower ground than where the two boys 
were sick, and using water from a well 
only sixteen feet deep, and there was an- 
other typhoid patient on an adjoining lot 
not more than fifty feet away, which I saw 
every day, at least twice, and several mem- 
bers of my family visited the sick a num- 
ber of times, yet we all had excellent 
health. All these cases recovered. 

I have made the assertion several times 
that typhoid properly treated should result 
in 95 per cent, of recoveries, except in cases 



of drinking men, where the chances of re- 
covering are very small indeed. 

My usual method of treatment is to give 
several small doses of calomel and soda. I 
use the tablet containing half a grain of 
calomel with sodium bicarb., giving 
one tablet every hour, or oftener, for five 
or six doses, or until we have free dis- 
charge from the bowels. This I repeat 
every day or two, giving in the meantime 
pretty good doses of bismuth subnitrate, and 
an antipyretic usually acetanilid with qui- 
nine sulph. If the fever nms high. I use 
the cold bath. 

As typhoid fever is a disease of the bow- 
els, it is necessary to keep a close watch 
of the discharges I believe the bismuth 
sheathes the inner lining of the intestine 
to such an extent as to reduce the danger 
of perforation to the minimum. I have 
never had an intestinal hemorrhage in this 
disease. 

I might cite other cases in which this 
disease seemed to follow families for sev- 
eral years, but the one given above is the 
most pronounced of any that has come 
under my observation. I might add that is 
my opinion, that if there is any medicine 
that will abort typhoid fever it is calomel. 
O. B. Surface, M.D. 

1618 Shelby St., Indianapolis, Ind. 



ATROPINE. 



Editor Medical Summary: 

Belladonna and atropine have been very 
valuable remedies to me in more than thirty 
years' practice. I want to emphasize all 
that was claimed for these drugs in the 
brief editorial note in January number of 
the Summary. One use may have been 
overlooked by some practitioners. 

In obscure abdominal conditions in the 
early stages, perhaps beginning with sud- 
den and severe pains, vrith symptoms only 
suggestive of the various serious troubles 
so liable in this part of our anatomy, gall- 
stones, appendicitis, many other itises, 
spasm, etc., belladonna or very small doses 
of atropine are remedies of inestimable 
value. Morphine is a deadly drug in such 
conditions. 

Belladonna is especially valuable in the 
treatment of children. Various affections 



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27 



of the respiratory tract respond to its medi- 
cinal virtue. I was called once to see a 
child seriously ill with violent convulsions; 
its skin was as red as distended capillaries 
could make it. I was about to administer 
belladonna when I thought to ask if the 
child had possibly taken some poison. Yes, 
it was found to have a vial I had given 
the mother containing one per cent, solu- 
tion of atropine, and had perhaps (surely) 
taken some of it. I gave the boy morphine 
enough to have killed him several times 
over under other circumstances, and there- 
by saved his life. 

I am having some experience with a 
novel method of administering atropine. 
It is well known that belladonna is useful 
in irritable bladder and enuresis of child- 
hood, and prostatic troubles with cystitis 
and irritable bladder of old men. I use 
the pin point tubes of ophthalmic ointments 
containing atropine in varying proportions, 
and apply the medicament under the fore- 
skin, especially around the corona glandis. 
It seems to have a decided local action with 
somewhat less systemic effect. Capillary 
circulation through the sexual organs is re- 
stored, a sense of vigor is realized, and ir- 
ritable bladder is relieved. 

Those of us who may be therapeutists 
should not feel entirely obscured by the sur- 
geons. If we know of anything good in 
medical therapeutics let us keep it promi- 
nent. There are those yet who are willing 
to be cured medically. 

W. H. Champlin, M.D. 

122 York Ave., Towanda, Pa. 



NOTES FROM PRACTICE. 

Bditor Medical Summary: 

A girl of 18, strong and athletic, with a 
^ood heart, underwent an operation for re- 
moval of enlarged tonsils a few days ago. 
She rallied slightly from the anesthetic as 
soon as the operation was over, spoke a few 
words, then lapsed into a state of passivity 
from which she died in about one hour. 
Surgical shock was assigned by the sur- 
g^eon and anesthetist as the cause. 

About a year ago another throat case 
happened in another town. A sturdy young 
man died after a tonsilotomy and so sud- 
denly as to bring dismay to the heart of 



the physician in charge. Are throat opera- 
tions dangerous or do they tend toward 
shock, or again, does the operation cause 
extravasation of blood into the lungs and 
thus delay the dissipation of the anesthetic? 
Throat operations are as a rule considered 
comparatively benign. Recently I had a 
delicate, anemic child of five operated on 
for tonsilitis with recovery rapid and un- 
eventful. 

Of late I have noticed the tardiness in 
the healing process of wounds that are 
cleansed with bichloride and carbolic acid 
solutions. So many agencies that exert 
their germicidal action by coagulating albu- 
min also have a devitalizing effect on nor- 
mal cells. We are likely to kill both nor- 
mal and abnormal cells with the powerful 
bactericides. More recently I have em- 
ployed chinosol, one of the newer antisep- 
tics and one that is non-poisonous. I like 
it very much as it causes no injury to the 
tissues and does not coagulate albumin nor 
break down granulations. At the same 
time it has equally the germicidal power of 
bichloride and carbolic acid solutions. 

It is sometimes a very difficult matter to 
judge the intensity of an illness in children. 
A year or so ago I was called in one night 
to see a child that had been suffering from 
bronchitis or a pneumonic process^ but all 
acute symptoms had now seemingly sub- 
sided. The rales were coarse, showing 
mucus in the larger tubes ; the child showed 
a considerable degree of weakness and 
blood depletion, but not in an extreme mea- 
sure. A dose of an expectorant containing 
a drop or two of ipecac was given. The 
child vomited a little and died. Such things 
are embarrassing to the doctor. They are 
not conducive to good sleep. It is always 
best to be guarded in the prognosis of chil- 
dren. The balance is so easily turned either 
way. 

This report sounds better, almost like a 
patent medicine testimonial. A few weeks 
ago I was called in to relieve a young wo- 
man who was in the* throes of an attack of 
acute gastritis. She is about twenty years 
old, married and the mother of a child 
three months old. Since the babe was bom 
she has suffered two or more severe at- 
tacks of gastralgia every week. During all 
this time she was being treated by a phy- 



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THE MEDICAL SUMMARY 



sician who gave her medicine, regulated 
her diet and told her to use Christian 
science while the spells were on, as medi- 
cine f«r their immediate relief would injure 
the baby. The patient asked me to con- 
tinue to treat her. 1 told her that would 
not be fair to her doctor, as I had been 
called in to see her only in emergency. She 
stated that she was going to change to 
some one else anyway, so I thought I rnight 
as well accept her case. I gave calomel 
and soda, followed by salts and a teaspoon- 
ful of cascara sagrada elixir at meal time; 
also at meal time a tablet containing vera- 
colate with pancreatin and pepsin. All 
these remedies were pushed to the extent 
of arousing the hepatic function and keep- 
ing the bowels open. Pork, pastry and a 
few other articles of diet were placed on 
the tabooed list. So far the patient has not 
had -one of her cramping spells. There is 
certainly nothing remarkable about the 
treatment, but I find that thorough elimina- 
tion will cure more ailments than any other 
one line of procedure. It should, however, 
be hooked up with an abundance of faith 
in the doctor. 

W. T. Marks, M.D. 
Peoria, 111. 



MORPHINISM AND ALCOHOLISM. 



Editor Medical Siunniary: 

The goat is practically immune to tj^c 
toxic eti'ects of opium, especially of its al- 
kaloid morphine. Bird^ are immune to it 
when given per mouth on account of non- 
absorption, but succumb readily when it is 
given hypodermically. This is not true of 
goats, for as high as 500 grains have been 
given intravenously and higher doses seem 
to offect the respiration solely. In the use 
of the modified serum as a therapeutic agent 
in the cure of the drug addiction when the 
altered lymphocyte ratio, the high acidity 
of the blood and the constant oxaluria are 
taken into account it seems that aside from 
its immunizing constituents that the nu- 
clein content has a great deal to do with its 
value in this regard. Now, in treating these 
addictions it is of great benefit in a certain 
number of cases to know whether they are 



using anything on the side, for where they 
are allowed their freedom to come and go 
at their pleasure, it is always to be on your 
guard as to outside help. The denial u to 
be expected, but if you can assert positively 
that you have absolute evidence of their 
guilt they then see that any further use is 
impossible without detection, the cure is 
hastened thereby. The urine affords us the 
best index, for they cannot alter the in- 
gredients so that it in any way affects the 
tests, for if alcohol is taken in any form 
( r in the minutest quantity it will be ex- 
creted in the urine. Acetone, aldehyde and 
alcohol give somewhat similar reactions, 
and in order to prove the presence of ihe 
last we have to exclude the other two. 
Aldehyde docs not enter into our investiga- 
tion, for it is seldom found in the urine, and 
then only if the distillation is continued too 
far. The tests conmionly employed are 
Gunning's, Lcgal's, Reynold'^, and Lichen's. 
Acetone responds to all four tests, alcohol 
to the last only ; so if we find a ne.^ative re- 
sult w^ith the first three and positive with 
four we are certain that we have alcohol as 
a constituent. The first three may be 
found in any recent work on physiological 
chemistry ; Licbcn\s is performed as follows: 
100 or 200 c.c. of urine are taken, acidified 
with acetic or phospho acids and dibtilled. 
Collect the first drops of distillate or what 
parses over render alkaline with potassium 
hydrate (liquor jk tassa) add drop by drop 
of iodine in a solution of potassium iodide 
(Lugol's s(.lution), and if alcohol is pres- 
ent a yellowish white deposit of iodoiorm 
results; this can be readily recognized by 
its odor and by the formation of six-sided 
crystals or rosettes. Confusion is some- 
times experienced when thymol is used as a 
pre.scrvative, for a reddish precipitate 
forms and may be mistaken for iodoform, 
but the characteristic crystals are a scent. 
This compound that is formed is iodo- 
thymol. In using the above serum it has 
responded to Legal's test, but this is prob- 
ably due to the creosols used to preserve, 
for the fresh serum does not give it. It is 
therefore well to use at least two tests for 
acetone before arriving at a definite con- 
clusion. 

A. F. Irwin, M.D. 
2219 Fairmount Road, Cleveland, O. 



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A TREATMENT FOR LOCK-JAW. 



Editor Medical Summary: 

On the evening of January 31, present 
year, njy wife stepped on a 40 wire nail, 
which entered the ball of the left foot 
about the middle, penetrating very deep. 
I was not at home at the time, but arrived 
about half an hour after, finding her in 
much pain. She had pulled the nail out 
and the wound bled copiously. I at once 
injected into the wound a solution of car- 
bolic acid, one dram to the ounce, then 
placed the foot in hot water, keeping it 
there for one hour, adding additional hot 
water from time to time as much as she 
could stand. When taking it out applied 
turpentine, which was repeated the next 
morning. The soreness disappeared and 
the wound healed kindly, so that on the 
third day she was able to walk on it. 

On the afternoon of February 5 she laid 
down and took an hour's nap, waking up 
with a stitY neck on the right side. Upon 
returning home about 7 o'clock p. m. on the 
evening of February 6, her neck was so 
stiff she could not turn her head, pains rad- 
iating up and down her spine and across 
the shoulder . Lightning pains in the right 
arm and left foot, with considerable uneasi- 
ness in the region of the wound; jaws be- 
ginning to set. I at once called the janitor, 
had him burn some hardwood into a quan- 
tity of live coals, place these coals in an 
iron kettle, and put the contents of two 
packages of cigar clippings onto the coals, 
open the wound in the foot with a bistoury, 
place the foot over the kettle as close to 
the smudge as she could stand it, covered 
the limb with a woolen blanket and kept it 
there until the tobacco was entirely con- 
sumed. In five minutes after placing the 
foot in position she was entirely relieved 
and all the pain had ceased. She could use 
her jaw with all freedom, slept well the 
balance of the night, was able to be up the 
next morning, and aside from a little sore- 
ness in the right mastoid muscle she felt 
fine. The only internal treatment given 
was sp. tr. lobelia 2 drams, sp. tr. sticta i 
dram, sp. tr. echafolta i ounce in aqua 
quantity sufficient four ounces. Teaspoon- 



ful every hour. Would tetanus serum act 
as promptly and efficiently? 

F. W. Lanoix, M.D. 
Junction BIdg., Kansas City, Mo. 



PNEUMONIA SEQUELA. 



Editor Medical Summary: 

The most serious results of pneumonia 
are hepatization and plural abscess, where 
there is the combination of pleuro-pneu- 
monia. Several times I have had the em- 
pyema to contend with, but I proceeded 
promptly ere it was too late, to have a 
thoracentesis performed. But by far the 
most tedious, serious and most intractable 
sequel is consolidation of one or both lungs. 
I have been called the second time recently 
to see a patient, aged 60 years, who has 
hepatization of the right lung. It is a grave 
condition. I think the case has passed from 
the red to the gray hepatization. Now, 
while all medical men will concede the 
gravity, and possibly the irremediability of 
hepatization, yet persevering treatment 
must be pursued. Nourishing and sustain- 
ing the patient is one of the most impor- 
tant considerations. I have had a case to 
get well, who went on a farm and pursued 
outdoor employment, and took iodized cod 
liver oil, syrup of hydriodic acid, and per- 
severed in their use. 

The question is what is the most effective 
treatment for hepatization? I don't think 
I ever saw a case where the left lung was 
so involved. Is it because the liver has 
something to do with bringing about this 
condition in the right side? I believe so. 

In looking up authorities on the treat- 
ment of consolidation of the lungs, I find 
nothing specifically good, but the mainten- 
ance of the strength, stimulants, judicially 
administered, and stimulating expectorants, 
with counterirritation with iodine, turpen- 
tine, etc. ; also inhalations of ammonia ar- 
omatic, with creosote, are perhaps all that 
can be done. The expectorants should con- 
tain either carbonate or muriate of am- 
monia, creosote, and cod liver oil. What 
else? D. L. Fielh, M.D. 

leff'ersonville, Ind. 



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Retinoscopy (Shadow Test). By James 
Thorington, M.D., Professor of Diseases 
of the Eye in the Philadelphia Polyclinic, 
etc. Sixth Edition ; revised and enlarged. 
P. Blackiston*s Son & Co., Publishers, 
Philadelphia. 191 1. Price, cloth, $1.00. 

We have before us a copy of the sixth 
edition of this valuable little book, which 
has been carefully revised and brought up 
to date by the addition of new illustrations 
and illustrations of new apparatus, and it is 
a real tnultum in parvo of the subject upon 
which it treats; so simply expressed that it 
can be readily appreciated by the practi- 
tioner who has paid very little, if any, at- 
tention to this branch of work, and it can 
be recommended to those desiring to be- 
come familiar with it. 

A Handbook of Medical Diagnosis. By 
J. C Wilson, A.M., M.D., Professor of 
the Practice of Medicine in Jefferson 
Medical College, etc. Octavo. 1436 pages, 
408 text illustrations and 14 full-page 
plates in colors and black. Third edition. 
J. B. Lippincott Co., Publishers, Phila- 
delphia. 191 1. Price, cloth, $6.00. 

This handsome, large volume, consisting 
of 1436 pages, is one of the largest treatices 
on the subject of Medical Diagnosis in the 
English language. It is a splendid work, 
presenting in attractive form the data of 
physical and laboratory diagnosis with what 
combines in reality to make it a complete 
text-book on practice minus treatment and 
pathology. 

It is divided into four paits: I. Medical 
Diagnosis in General. II. Methods and 
Their Immediate Results. III. Symptoms 
and Signs. IV. Clinical Applications. 

The fact that three editions of this work 
have been called for in less than two years 
time is a remarkable record, and one that 
indicates on the surface at once a quick, 
or rather immediate recognition by the 
profession of the intrinsic worth or value 
of this volume. 



The well rounded-out experience the au- 
thor has had in the principal hospitals in 
Philadelphia fitted him well for the per- 
formance of the task which he has so ably 
accomplished in the bringing out of this 
admirable work. 

Audel's Answers on Automobiles for 
Owners, Operators, Repairmen. By 
Gideio Harris and Associates. Theo. 
Audel & Co., Publishers, 63 Fifth Ave., 
New York. 1912. Price, cloth, $1.50. 

The subject matter of this book is pre- 
sented in the form of questions and an- 
swers ; where technical terms are used they 
are either explained or made clear in the 
answer. The answers are short and direct ; 
giving simply the information wanted in a 
simple and concise manner. In fact, the 
object of the book is to give, in a form so 
simple and concise that any person can 
easily understand it; the information neces- 
sary for the proper operation, care, and 
maintenance of an automobile. It is stated 
that the man who is a first-class horseman 
will usually make a first-class driver of an 
automobile, or in other words, the man who 
shows mercy to a beast, will show mercy 
to his car. 

This is certainly a valuable book for 
those owning and those expecting to own 
a car in the near future. 

Practical Electro-Tiierapeutics and X- 
Ray Therapy, With Chapters on Photo- 
Therapy, X-Ray in Eye Surgery, X-Ray 
in Dentistry, and Medico Legal Aspect 
of the X-Ray. By J. M. Martin, M.D., 
Professor Electro-Therapeutics and X- 
Ray Methods, Medical Department of 
Southwestern University, etc., etc., con- 
taining 219 illustrations. C. V. Mosby 
Co., Publishers, St. Louis, Mo. 1912. 
Price, cloth, $4.00. 

This work has been prepared for the stu- 
dent and general practitioner, and only such 
features of the diagnostic and therapeutic 



30 



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31 



work introduced that were thought to be of 
practical use to the busy family doctor de- 
sirous of an intelligent understanding of 
this specialty, but not having the time for 
more extended study of the subject. One 
thing to be admired about this book is that 
it largely represents the experience of the 
author, and that technicalities have been 
avoided. The photographs and skiagraphs 
are from the author's private collection, in- 
troduced as practical examples of the ef- 
ficiency of the methods described. 

Electric and x-ray methods are receiving 
merited recognition as diagnostic and ther- 
apeutic agents, and the physician who dis- 
regards these methods might be accused 
of neglect. The general plan of this work 
is excellent, practical from beginning to 
end, and one of the best for clearness of 
the subject presented, and will fill the need 
for the general practitioner's use better than 
any work of the kind heretofore brought 
to our notice. 

SscoND Rbview of Some of the Recent 
Advances in Tropical Medicine. Being 
a Supplement to The Fourth Report of the 
Wellcome Tropical Research Laboratories 
at the Gordon Memorial College, Khar- 
toum. By Andrew Balfour, M.D., Direc- 
tor, and Captain R. G. Archibald, M.B., 
R.A.M.C., Pathologist and Assistant Bac- 
teriologist. Published for Department of 
Education, Soudan Government, Khar- 
toum, by Bailliere, Tindall & Cox, Lon- 
don, Depot for United States Toga Pub- 
lishing Co., 35 W. 33rd St., New York 
City. 191 1. Price, cloth. $375. 

This Second Review, or Report, deals not 
merely with diseases represented in the 
Anglo>Egyptian Sudan, but with tropical 
diseases in general, thus taking in a 
much wider scope, and becoming a 
better book of reference. It is a large 
volume of 446 pages, elegantly printed on 
heavy paper, including 30 pages of index. 

Below we give a summary of its contents, 
which will give the reader a better idea of 
the scope of this work than any further 
comments we could make. 

Air, Ankylostomiasis, Anthrax. Bacteri- 
ology, Beri-beri, Beverages, Blackwater 
Fever, Chicken-pox, Chigger, Cholera, Cli- 
mate, Clothing, Dengue, Diarrhea, Disin- 



fection, Dropsy, Dust, Dysentery, Elephan- 
tiasis, Enteric Fever, Feces, Fevers, Filari- 
asis. Filters, Flies, Food, Food Poisoning, 
Goundou, Guinea Worm, Hematozoa, Heat 
Stroke, Hydatid, Hydrophobia, Influenza, 
Insects, Leishmaniasis, Leprosy, Liver Ab- 
scess, Malaria, Malta Fever, Measles, Milk, 
Mosquitoes, Mycetoma, Myiasis, Ophthal- 
mia, Oriental Sore, Parasites, Paratyphoid 
Fever, Pellagra, Phlebotomus Fever, Piro- 
plasmosis. Plague, Pneumonia, Preserva- 
tives, Protozoa. Refuse Disposal. Schisto- 
somiasis, Scorpion Sting, Scurvy, Sewage, 
Skin Diseases, Sleeping Sickness, Small- 
pox, Snake Bite, Spirochetosis, Sprue, 
Staining, Syphilis, Technique, Tetanus, 
Ticks, Tropical Medicine, Trypanosomiasis, 
Tsetse Flies, Tuberculosis, Typhus Fever, 
Vaccination, Vermin, Verruga, Veterinary 
Diseases, Water, Whooping-Cough, Yaws, 
Yellow Fever. 



LITERARY NOTES. 



The issue of "Harper's Weekly" for Feb- 
ruary loth contains, among other articles, a 
vivid presentation of the battle between the 
Merrimac and the Monitor, by H. Ashton 
Ramsay, who served on board the Confeder- 
ate vessel. It is entitled "The Most Famous 
of Sea Duels.*' Other articles in this issue 
are: "An Old Likeness of Lincoln," by Tru- 
man H. Bartlett: "Down With the Art Jury/' 
by Samuel Swift; "The Humor of Spain," by 
Charles Johnston; "The King of Winter 
Sports," by Edward Bayard Moss; "The Red 
Flood in Germany," by Sydney Brooks, etc. 

One of the most sensible as well as prac- 
tical articles that we have seen for quite a 
while on that interesting subject "Back to 
the Farm" is by Dr. H. W. Wiley, and ap- 
pears in the February "Century." Of course 
this is only one of the many interesting ar- 
ticles appearing in this issue of the "Cen- 
tury," which always gives the best of every- 
thing in literature of a high-class nature. 

The January number of the "Popular Sci- 
ence Monthly" is a valuable issued, inasmuch 
as almost everything in it will interest the 
physician who prides himself in his general 
culture. The Mechanistic Conception of Life, 
by Jacques Loeb; The Problem of City Milk 
Supplies, by Dr. P. G. Heineman; The Origin 
and Control of Mental Defectiveness, by Dr. 
Charles B. Davenport, are of immediate im- 
portance to him, while other contributions^ 
on science in Paris and in China, small col- 
leges, coral reefs, etc., will add to his mental 
equipment. 



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\'eratruni i> called for in pneumonia by 
pyrexia, with a full and bounding pulse. 

Do not ncj^Iect the tonsils in cases of 
mouth breathing pointing to nasal obstruc- 
tion. It they are enlarged, rem<>ve them. 

A ilucoulent curd is the keynote to per- 
fect infant digestion; attention, n(;t niedi- 
catinii, is the way to accomplish it. 

\\"ithoui. trc^h air your ca^i- of mal-nu- 
trition will not get well; a trip or.t of doors 
every day should be a part of tlie routine. 

Do not rely exclusively upon topical 
means m treating ati'ections of the nose. 
Tonics are always indicated when the gen- 
eral sy>t<Mn is- at fault. 

Zinc [)h«>s|)l;i(l^.- is not oi.ly an excellent 
nerve tonic, but it is ^aid to materially bene- 
fit the general c(*n(lition in epileptics. It 
deserves a trial. 

I[)ecac in small doses, given in c<jnjunc- 
tion or in alternation with aconite, or bry- 
onia, or belladonna, is of great .service in 
pncr.T.'ini.i. e-^tcu'ally in that of cidldreii. 

h'laiinel .d<.tlis wrung out of hut water, 
and saturated with oil or spirits of turpen- 
tine 'Hid applied directly, relieve deep-seat- 
e<l pain i'l the chest, stomach, abdomen or 
kidney. 

Acute uidannnation, ulcer and carcinoma, 
are aboiu the only diseases the stomach is 
subject to, symptoms frequently referable 
to the stomach, come from liver and gall 
bladder troubles. 

Podophyllin is good in constipation where 
there is dizziness, coated tongue and bitter 
taste, and jaundice with clay-colored stool. 

Codeine relieves cough even better than 
morphine, wdiile the disagreeable after-ef- 
fects are far milder. 



'i annin r^.iid glycerin, equal parts by 
V eight; mix. and apply several times a 
day, for piles. .Same for sore nipples; and 
for excoriation and abrasion from any 
cause. 

lu'hinacea has been used as a wash in 
jiurulent Iei:c' rrhea with benefit, aLso in 
extensive erysipelas with stupor and intense 
constitutional s\ni[)toms. with excellent re- 
sults. 

Tiunor or a movable i}ear-shaped umss 
V. hich can be palpated in the region of the 
gall-bladder indicates either obstruction of 
the cystic duct whith a stone and disten- 
tion of the viscus with nnicus, or the ob- 
struction of the common duct by cancer 
ai'd the distention of the ori:an with bile. 

Any intelligent phy.Mcian can add to his 
gc ;ieral training a kn'owledge of refraction 
th.at wiil enable him to succeed, if he makes 
an honen elYort. lie can certainly do bet- 
ter work than the optician, or peddler, who 
knows nothing of what he is doing except a 
few mechanical principles, but nothing of 
their r«.1ati(ms to the human body. — Dr. 
.-lycrs. in }\'iical Times. 

Turpentine on sugar, three-drop doses 
every half hour taken, and topical applica- 
tions marie to the throat and chest by flan- 
nel cloths wrung out of hot water and 
saturated with turpentine (the applied 
cloths covered with dry compresses), is 
considered a sovereign remedy for croup. 

Indigestion is the earliest and most fre- 
quent symptoms of gallstones. It is not 
produced by imprudence in eating, conies 
on without definite relation to taking foo«i, 
and is usually relieved by vomiting. Per- 
sistent and intractable indigestion that does 
not yield to treatment is usually due to 
some organic lesion in the abdomen, such 
as appendicitis, ulcer or gall-stones. — Va. 
Med. Semi-Monthly. 



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A MoDthbr Journal o( 

Practical Medicine, New Preparations, Etc 

R. H. ANDREWS, M.D., Cdiler and Publisher, 2321 Park Ava*. PhOa.. Pa. 
OiM Dollar Par Aamtm in AdTaaoa. Siatfa Coplai. 10 Caoti 



VoL XXXIV. 



Phaa<M|)hia.ApnL1912. 



No. 2 



SUBSOaZPTION BATES: 11.00 p«r y««r, in md- 
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VSW SUBSOBIPTIONS may begin at any tluM dnr- 
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HOW TO BEMIT: A iafe way to remit la by postal 
money order, express order, cheek, draft, or regis- 
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sent mnst be at the risk of the sender. 

BEOETPTS: The receipt of all money is immedi- 
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GHANQE8 OF ADDBE8S: Subscribers changing their 
addresses thonid immediately notify us of their 
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in such cases, unless we are thus notified. 

DIBOOH TJLN U AKOES : The Summary is oontinued to 
responsible subscribers until the publisher is noti- 
fied by mail to discontinue, when payment of all 
arrearages must be made. If yon do not wiSh 
The Summary continued for another year after 
the time paid for has expired, please notify ns to 
that effect. 



•'THE MEDICAL SXJMMABT,*' 
2S81 Park Ato., - Philadelphia, Pa. 

Entered at Phila. Post OfRce as second-class matter. 

DISPENSIHO AGAIN. 

This is an ancient topic, but we will be 
brief. This agitation all started from the 
drug trade. A traveling man who sells to 
physicians stated to us recently that few 
of the drug stores would buy anything 
from the supply houses that cater to phy- 
sicians. Most of the houses that do sell 
to both druggists and physicians — for some 
of them do — have two prices : one for phy- 



sicians, the other for druggists; the latter 
get their goods at a lower price. The only 
reason for such discrimination is that the 
<iruggist may be a more voluminous buyer. 
We do not make these statements in any 
spirit of antagonism to anybody^ and if 
they are erroneous we invite a "come- 
back" from anybody whose toes may be 
trampled on. We are for the general prac- 
titioner of medicine first and always, but 
we desire to be fair to everybody. 



ON DIAGNOSIS. 



It is the clinician's duty to recognize 
every abnormal condition presented by a 
patient and the probable pathologic causes. 
Refined diagnosis goes still further — it 
makes clear the interdependence of various 
morbid states presented by one patient. An 
individual may have two distinct diseases 
at the same time; much more frequently 
the several conditions arise in sequence, 
one causing another, or all may be due to 
one underlying morbid process. We have 
known three clinicians of world-wide repu- 
tation make the diagnoses respectively: 
Valvular heart-disease, abdominal aneurism^ 
organic disease of the spinal cord, in the 
same patient; not one recognized the three 
conditions present or the fact that general 
arterial disease was the underlying evil. 
Accurate treatment follows naturally ugon 
accurate and ultimate diagnosis. In other 
cases, if accurate, the treatment is acci- 
dental. 



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34 



THE MEDICAL SUMMARY 



THB DANGEROUS AGE IN WOMAN. 



This is the title. of a book recently pub- 
lished across the big pond, and its advent 
las caused great excitement in all the large 
cities of Europe. A hundred editions have 
already been sold, and it has been trans- 
lated into a score of languages. Booksell- 
ers have piled copies of this book on their 
fihehres like cordwood, and it has sold as 
Yeadily as whiskey in a mining town. 

The author is a woman, one Karin Mich- 
aelis. We used to think the 'teens and 
early twenties constituted the dangerous 
age — if such an age there be — in females. 
This author, or authoress if you like it bet- 
ter, says not. According to her diagnosis, 
35 to 40 is the time of most danger. It 
"would require columns to tell why the 
writer believes this to be true. Woman is 
as a rule at her best both mentally and 
physically at this age. Romance has not 
yet entirely gone out of her life. Domes- 
ticity is monotonous and often palls upon 
Jier. Marital life is somewhat of an illu- 
sion. Connubial love does not measure up 
to the dreams of maidenhood. And to 
crown the unfortunate affair, the home is 
too often childless. 

In an article inspired by the reading of 
this book, Newell Dwight Hillis, the emi- 
nent pastor of Plymouth church, in Febru- 
aiy Good Housekeeping, discusses the 
''dangerous age" from several different 
angles and viewpoints. He does not allot 
any specific age in women as being espec- 
ially fraught with danger, yet between the 
lines he admits that there is much truth in 
the sensational novel in question. He says : 
""Middle age is the dangerous age because 
it is the age of disenchantment and lost 
illusion. By this it is not meant that the 
rule of life is that experience strips away 
the dreams and leaves women disappointed 
with their husbands, their children, their 
homes, their friends and their community. 
But whoever journeys out among men 
knows that not all women are satisfied with 
the man they have married, and that there 
come epochs in her life when the woman 
realizes that she does not love the things 
her husband loves, and that she does not 
hate the things he hates. 



"In youth Romeo and Juliet sit with 
clasped hands, eating rose leaves, and the 
very fog bank is made glorious by moon- 
light. At last there comes a time when 
tinkling raindrops no longer stand for mu- 
sic in the ears of youth, but the dampness 
suggests for old age rubber overshoes, red 
flannel and gooseoil for a sore throat." 
Dr. Hillis states that it is the shattering of 
these idols and ideals early in life that 
quite often prompts the woman of middle 
age to take a last-chance, now-or-never 
venture from the straight and narrow path 
of rectitude. "Others have walked the 
primrose path of dalliance, why should she 
not pluck at least one flower and slip back 
into the path before anyone finds it out? 
Who built the hedge and shut the soul in? 
If men break down the hedge and go out 
to loot the world, why should not a woman ? 
She forgets the gate of Eden was to shut 
serpents out, not to close souls in." 

Womankind being peculiarly amenable to 
suggestion, sex literature of a psychologi- 
cal rather than a scientific^ trend is calcu- 
lated to exert more harm than good. 



THE POST-PARTUM STAGE. 



The clearing out, shrinking and rejuve- 
nation of the uterus after confinement va- 
ries remarkably in women. Some are as 
strong at the end of three days as ethers 
are after three weeks have elapsed. Sub- 
jective strength and a sense of well-being 
are not, however, always safe criteria on 
which the woman can base her behavior. 
It takes thirty days for involution to com- 
plete itself. Sometimes the uterus has not 
resumed its normal size and condition for 
six weeks. And if the woman persists in 
being on her feet too much and doing an 
undue amount of work, subinvolution may 
follow. 

Since the recumbent position is desirable 
for a number of days after delivery, ob- 
stetricians and nurses have too often gone 
to the extreme of keeping the woman flat 
on her back. This is all wrong. A supine 
position too long maintained favors hypo- 
stasis and prevents clots and debris from 
being freely expelled. There are seldom 



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THE MEDICAL SUMMARY 



35 



present such pathological states as will pre- 
clude the woman arising to pass the urine 
and feces. If she can assume an upright 
position for this purpose it makes for her 
safety and health. The woman who is kept 
flat on her back and her urine and feces 
thus passed may get along normally; too 
often she does not for reasons quite ob- 
vious. Getting up does not hurt the wo- 
man just recently delivered; it is the stay- 
ing up that hurts her. 

The decupitus of the lying-in woman 
should be varied. Above all, she should not 
lie constantly on her back. If involution is 
slow, no position is so salutary as lying 
on the stomach a part of the time. The 
woman should occupy a recumbent posture 
the greater part of the time until three 
weeks have expired. It is not, however, 
absolutely necessary in all cases to remain 
in bed the entire first ten days. But she 
should avoid being on her feet too much 
or doing anything requiring severe strain- 
ing or lifting until the process of involution 
is about complete. 



INTESTINAL SEPSIS IN OCULAR 
AFFECTIONS. 

The above is the title of a reprint article 
by Dr. Samuel D. Risley, Philadelphia. The 
article is ably written and reflects careful 
study and research on the part of the writ- 
er. He takes the stand that many ocular 
affections, cataract as well as many condi- 
tions of lesser severity, are often due to 
toxemias originating from the intestinal 
canal or from insufficient renal elimination. 
Constipation and its consequent autotox- 
emia, coupled with insufficient food, bad 
hygiene, poor teeth, etc., are far-reaching 
in scope, especially in the effects upon the 
neuro-vascular systems. Ocular blood pres- 
sures and congestions often are either di- 
rectly or indirectly traceable to the absorp- 
tion of septic matter from the alimentary 
canal. 

It is true that we do not know all about 
auto-intoxications, but we do know that 
this is the key that unlocks many seemingly 
obscure abnormalities. Many of the affec- 
tions in children for which glasses are so 
frequently prescribed would be better met 



by calomel and salts, good hygiene and 
wholesome living. Any treatment will 
prove unavailing if the eyes are still over- 
used and abused. The writer states that he 
seldom operates for cataract without first 
having administered cathartics to the pa- 
tient. He points out the far-reaching drain- 
age, even to the eyes, of thorough elimina- 
tion from the intestinal canal. Dr. Risley 
does not operate for cataract until the ali- 
mentary canal is freed of its toxic and mi- 
crobic elements, the urine of normal spe- 
cific gravity and free from indican, albu- 
min and excessive acidity, and the blood 
pressure approximately normal. This salu- 
tary state will, according to the author, be 
rapidly brought about by the daily or tri- 
weekly administration of sulphate of mag- 
nesia or some of the other alkaline earths. 



DISPENSING DANGEROUS DRUGS. 

We sometimes can*t blame certain indi- 
viduals and sects for being knockers on 
strong drugs and accusing us of drug- 
ging (?) our patients. We do not believe 
that drugs are dispensed as safely and as 
sanely as they should be, that some drugs 
should be left unmanufactured and that 
certain formulas and combinations carry 
with them too much danger. It is no un- 
common thing to read in the daily prints 
of some child succumbing to samples of 
pills thrown on the porch. A few weeks 
ago a girl in a western city, died from a 
douche in which a bichloride of mercury 
tablet had been dissolved. Bichloride of 
mercury as an antiseptic is not needed at 
all, and can be replaced by numerous other 
safe agencies. We also recently called at- 
tention to a case of poisoning in which the 
young woman had taken a one-grain tablet 
of morphine. Why should this or any other 
drug be put up in a dangerous dose? And 
what is the use of cyanide of potassium 
and other deadly drugs? They may kill all 
right, but can never save a life. Strych- 
nine is a drug that has been woefully mis- 
used with a view to "stimulating the heart." 
In times past aconite was used in a way 
that did more harm than good. It is a 
drug which may do good sometimes, and 
when given as aconitine the dosage is de- 



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36 



THE MEDICAL SUMMARY 



finite. Quinine is not a harmless drug — in 
fact, it does harm almost invariably when 
given in large doses for some length of 
time. Let us not be drug nihilists — they 
are useful and many of them are curative — 
but let us prescribe intelligently and try so 
far as possible to eliminate dangerous rem- 
edies. We are all gradually getting around 
to smaller doses and more of them, if nec- 
essary, and in the future much of the 
trashy, dangerous stuff we have been using 
will be thrown out. 



WHAT SHALL I GIVE THE PATIENT? 



This is the question that confronts the 
physician many times a day. Your box of 
pills or your hieroglyphics on a prescription 
blank may spell hope to the patient. But 
do you always stop to think, doctor, that 
you are giving the patient a part of your- 
self? You are doing it, although it may 
be subconsciously. We can't possibly get 
along without surgery and pills, it is true, 
but after all the greatest healing agency in 
the world is the subtle, intangible some- 
thing known as psychic power. We can't 
define it clearly — ^yet. It nevertheless ex- 
ists. Psychotherapy is only in its infancy, 
and inexplicable as it may be, it is a reality. 
. Give the patient a part of yourself, doc- 
tor. Take time to study his case from both 
symptomatic and psychic viewpoints. Im- 
bue him with courage. An iron will is the 
greatest antitoxin in the world. Let the* 
patient know that your interest in his case 
is intense and from the heart. Apply your 
psychotherapy through simple and human 
agencies. Do not bore him with your su- 
perior knowledge. Try to overcome his 
morbid introspection and get him on a 
hopeful and optimistic plane. 

After these things have been done, your 
medicines will take effect. Tell him about 
what results he may expect from the medi- 
cation, making broad and general assur- 
ances. Hopeful expectancy is a mighty ad- 
junct to any remedy, provided the patient 
is not too far removed from the "earth 
earthy." The patient needs the physician 
himself as much as he needs his prescrip- 
tfion pad. 



A HATTER OF EUGENICS. 

The Kansas legislature has for its con- 
sideration a bill which in the event of its 
becoming a law will make marriage less 
easy. The contracting persons to the mat- 
rimonial alliance will be required by law to 
publish the announcement of their marriage 
a few weeks in advance of the event. Fur- 
thermore, the man and woman must be sub- 
jected to a medical examination and given 
a clean bill of health before marriage can 
be consummated. Our civic authorities and 
the people in general decry the too frequent 
granting of divorces. The fault does not 
lie so much in our lax divorce laws as in 
the ease with which people enter into the 
bonds of matrimony. Much suffering, pov- 
erty and disease can be spared whenever 
we have universal laws by which people 
enter upon married life with serious fore- 
thought. 



DEFINITE DLAGNOSES. 



We are arriving at exactness in the mat- 
ter of diagnosis. Loose and elastic terms 
are now being eliminated. "Malaria," 
"typho-malaria," "lazy liver," "hysteria," 
"neurasthenia," "railroad spine," and other 
terms lacking in definiteness and perspic- 
acity are going out. With our modern 
knowledge of microscopy, urinalysis, vac- 
cine reactions and a more exacting study 
of disease from a clinical point of view we 
are coming more and more to recognize 
pathological states rather than disease 
names. After all, disease names are useful 
only to satisfy the minds of patients. It is 
the central aim of the physician to recog- 
nize pathological processes in their very 
incipiency before symptoms are strongly in 
evidence. A tuberculosis or nephritis, for 
instance, ought to be discovered before the 
prominent clinical phases are manifest. 



To retain cotton on a probe, rub a little 
wax on the probe, warm slightly, and wrap 
the desired amount of cotton on. The wax 
cools and retains the cotton and can be 
warmed again and the cotton readily re- 
moved. 



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TREATMENT OF ABSCESS AND FISTULA 
OF THE RECTAL REGION. 

By Rollin H. Barnes, M.D. 

Editor of The Proctologist, Professor of Proctology 
in the American Medical College in Affilia- 
tion with Barnes UniTersity. Form- 
erly Professor of Rectal Dis- 
eases in St. Lonis College 
of Physicians and 
Surgeons. 

The origin of fistula is the abscess, and 
in order to be able to handle your patients 
properly that are suffering with an infec- 
tion of pus forming bacteria in this region 
it is necessary that the general practitioner 
is able to recognize the abscess formation. 
If the abscess is properly treated few in- 
in fatty digestion as antacid. 

From my experience with fistula I am 
satisfied that few general practitioners 
really know or realize the importance of 
the early recognition or care of abscess in 
this region. I had recently a patient that 
illustrates how these are treated generally. 
A young man of 23 years, five years ago, 
had an acute infection of the right ischio- 
rectal fossae. The physician consulted stat- 
ed that he did not know whether it was 
abscess or a boil. He opened it but not 
correctly, instead of remembering the rule 
for opening an abscess of this region, if he 
had ever been taught proctology in his 
medical school. He made his incision far 
enough posteriorly but not anteriorly. It 
was very evident for the abscess extended 
anteriorly into the perineum, whereas they 
mostly extend posteriorly toward the con- 
nection with the space of the opposite side. 

Remember to make your incision as long 
or a little longer than the greatest width 
of the abscess cavity so that there is no 
blocking by the overlaying skin to your 
drainage. This physician failed to open 
the abscess cavity far enough anteriorly, 



the overlaying skin blocked the drainage, 
and the infection extended in that direc- 
tion. 

Many text-books speak of curretting fis- 
tula and abscess cavities. This is wrong. Re- 
member that you have an infected wound 
and that mostly infection extends by the 
way of the lymphatics. In curretting you 
not only open the lymphatics but you rub 
in the infection. Never currette an infect- 
ed wound. 

Another statement that is largely follow- 
ed is the packing of wounds. You may 
pack a wound if you desire to stop bleed- 
ing, but this is rarely necessary in abscess 
or fistula. If you use gauze be careful to 
lay it in the wound straight. If you as a 
boy remember when the coal-oil lamp was 
in general use that occasionally the wick 
became folded upon itself, and the lamp 
would not burn, so it is with the pus secre- 
tion we wish to drain from the infected 
wound of an abscess or fistula. Rubber 
strips or rubber tubes may be used for 
drainage, and sometimes in shallow cavi- 
ties it is better not to use any of these ma- 
terials, for the wound will heal better with- 
out them. 

I have seen cases, in which the wound 
made to open the internal opening (Re- 
called) in the anus, healed, leaving a sul- 
cus. This is the result of packing, and in 
many of these cases the continence is not 
perfect. I have seen these results not only 
where the sphincter had been cut but in 
cases where the tract connecting with ^he 
anal canal was external to the sphincter 
which had not been cut. ' 

The treatment of fistula largely follows 
the principles used in the treatment of ab- 
scess. The fistula is often more complex, 
and it takes closer observation to outline 
how (and where it extends) the opening 
up should be, but we must always keep in 
mind that th^ object is drainage. 



57 



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38 



THE MEDICAL SUMMARY 



As a rule there is less danger in opening 
too little than too much. We should re- 
member that we should not cut muscle 
fibers at right angles to obtain free drain- 
age except when it is absolutely necessary. 
Never cut muscle fibers at an obtuse angle, 
rather separate the fibers. The most fre- 
quent example of the necessity of cutting 
the muscle fibers at a right angle is the ex- 
ternal sphincter and remember that its fib- 
ers are not circular to the bowel wall but 
extend from the coccyx to the perineal 
body. 

The after-treatment is of great impor- 
tance. Examine the wound carefully every 
day and do not allow any bridging over to 
take place that will obstruct drainage. Sep- 
arate such places with a probe or some dull 
instrument. Remember when these become 
firmly attached that it is painful to separ- 
ate them. 

Remember that the time to cure these in- 
fections is when they are abscesses, and I 
hope that this short effort will stimulate 
some of you who read it to be more careful 
and pay attention to these patients early, 
for you will prevent a world of suffering. 

Metropolitan Bldg., St. Louis, Mo. 



♦RECURRENT VERTIGO FROM HYPA- 
DRENALISM CURED BY OPOTHERAPY. 



of the skin. Naturally the examination of 
the cerebellar and labyrinthine functions 
was very minute; but it showed no anomaly 
whatever. The patient used to have these 
vertiginous attacks suddenly, irrespective 
of any difference in psychological state. 
She would fall forward, not unconscious, 
but completely vertiginous. Objects went 
round, and the floor seemed to ascend and 
hit her in the face. I therefore believed 
that she had no psychasthenia, but func- 
tional instability of the vaso-motor appar- 
atus, possibly including that governing the 
vestibular centers or the labyrinth, as when 
an attack occurred there was a roaring in 
the ears. On considering the bruisability 
of the tissues, I thought that this might be 
due to a lack of adrenalin. Believing then 
that these attacks were possibly due to a 
morbid dilatability of blood-vessels, with 
consequent hyperaemia of the vestibular ap- 
paratus in some part of its course, I sug- 
gested adrenal substance. This was given, 
and the attacks ceased for several months. 
Then she was three months without adrenal 
substance and had an attack. Then con- 
tinued adrenal, and has had no attack since. 
The "phobia" has disappeared, as was to 
be expected, it being in reality a fear of 
falling natural in the circumstances and 
not a true phobia. 

1758 K St., N.W., Washington, D. C. 



By Tom A. Williams, M.D. 



Editor, Corresp. Memb. Paris Neurological Society, 
etc.; Nenrologist to Epiphany Dis- 
pensary, Washington, D.O. 



This case was referred to Dr. Wilfred 
Barton, of Washington, on account of his 
belief that the patient had psychasthenia, 
with request for instructions as to psycho- 
therapeusis. She was a woman of 29, sub- 
ject to attacks of vertigo, and in great fear 
of going outside of the house in conse- 
quence. The patient when I examined her 
showed a complete absence of hysterical 
tendencies, i. e., there was no higher sug- 
gestibility, nor were there any psychas- 
thenic stigmata; so I concluded that the 
case was not psychasthenic. 

Physical examination was negative with 
the exception of a slight exaggeration of 
the deep reflexes and a great bruisability 

^Philadelphia Neurological Aisociation, Oct., 1011. 



SUGGESTIONS IN TYPHOID. 
By D. W. Reed, M.D. 

In the February number of the Summary, 
page 369, is an excellent report of a long 
tedious case of typhoid fever, upon the 
management of which I wish to offer a few 
friendly criticisms and suggestions. If some 
reader sees fit to criticise the critic's criti- 
cism, so much the better. ''Let in the light." 

First, I wish to highly commend the doc- 
tor's idea of thoroughly cleaning out the 
alimentary canal at the very beginning of 
the treatment. I would suggest a large 
dose of epsom salts to follow the broken 
dose of calomel, etc., in order to flush out 
as many of the typhoid germs as possible. 
I also heartily agree with the doctor in his 
use of hydrotherapy as his chief antipyretic 



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Ko other antipyretic known is equal to an 
intelligent use of water. An excellent ad- 
dition to the treatment would have been a 
wet sheet pack after the hot blanket pack, 
or cool compresses over the entire trunk 
from chin to thigh, as well as to the head. 
These should be renewed by wringing out 
of cold water as often as they get warm. 
Now, my chief criticism is that the doc- 
tor "added fuel to the flame." No fireman 
who is "on to his job" would expect to ex- 
tinguish a large fire by pouring or sprink- 
ling on coal oil or any other combustible 
material; and no doctor who is familiar 
with the bacteriology of typhoid fever will 
feed his typhoid patient with the most ex- 
cellent culture medium known for the de- 
velopment and distribution of typhoid fever 
bacilli. 

Every physician of the 20th century 
should know that milk is the most favorable 
medium known for the development and 
distribution of typhoid fever germs. Then 
why does the doctor feed his typhoid fever 
patient milk? 

Authorities f Yes, we have many obso- 
lete authorities for it, but we also have ob- 
solete authorities for bleeding patients for 
all sorts of ailments; but these ancient au- 
thorities are seldom followed at the present 
time. With our present knowledge of bac- 
teriology and how disease germs are cul- 
tivated, distributed and destroyed, it seems 
that there is almost no excuse for feeding 
a typhoid fever patient milk, except butter- 
milk containing a large percentage of lactic 
acid. The doctor mentions giving his pa- 
tient salol. That certainly was an act in 
the right direction — to make the alimen- 
tary canal an unfavorable place for the de- 
velopment of the germs producing the tox- 
ins which cause the fever. Now, if he had 
followed up this idea by feeding the patient 
food that would nourish the patient but 
starve the germs his idea would have been 
most excellent indeed. 

Such a diet is any sort of fruit that con- 
tains a fruit acid. The best of all is prob- 
ably the juice of grapes. The tartaric acid of 
grapes not only greatly retards the develop- 
ment of typhoid fever germs, but it is an ex- 
cellent drink for the patient, and it is nour- 
ishing. You will all remember that your 
instructor taught you in your course in bac- 



teriology that your media must be neutraf 
or slightly alkaline in order ta produce a ' 
tremendous growth of germs in your test 
tubes and petri dishes in the incubator. If^ 
then, we wish to inhibit the growth, of thei 
germs we will render the media ocwi. Th«f«- 
fore, if we do not wish our patient tcK lir- 
''flat on his back" for "fifty-four dajts" or- 
longer, acidulate his alimentary canal audi 
keep it acid. 

Any kind of stewed fruit containing acid^ 
acid buttermilk, even hydrochloric acid add- 
ed to all the water the patient drinks, will 
greatly inhibit germ growth and make re- 
lapses far less frequent. 

I will not call it "aborting" the disease;, 
but just call it starving the germs to death 
and feeding the patient. 

One more point of criticismy if yotur 
patience is not already exhausted^ and that 
is upon the administration of coal tar anti- 
pyretics. These antipyretics do indee^^ 
make the temperature lower for a time, 
but how do they do it ? By eliminating the 
toxins from the body of the patient? 
No; but by depressing the vital forces by- 
producing a species of paralysis which not 
only does not aid in the excretion of tox- 
ins, but greatly inhibits such excretion sc^ 
that when the effect of the drug is gone 
the patient is in far worse condition thai» 
before the administration of the autipy- 
retic. So then success in treatii^ typhoid 
fever depends upon two fundamental prin- 
ciples : 

1. Clean out the alimentary canal and 
keep it clean with salol, sulphocarbolatcs^ 
and acid. 

2. Apply hydrotherapy internally,. «xtBr=- 
nally and eternally. 

The writer has followed this method lor 
sixteen years and has never lost a single 
patient, and has never had but one pa- 
tient whose fever lasted more than 21 days^ 
and nearly all are convalescing in. fcon& 
eight to twelve days. 

Above it? No; I just make the alimen- 
tary canal an unfavorable place to develo|> 
bacillus typhosus, and he dies a natural 
death. An after thought, in a doutitlnt 
diagnosis of malaria, the microscope will 
clear up the diagnosis, and in typhoid fever 
the Diazo and Widal reactions are helpful. 

Greely, Colo. 



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THE MAXIMUM DOSAGE OF WELL- 
KNOWN DRUGS. 

-By Douglas H. Stewart, M.D. 



My -experience with the few drugs short- 
ly to be mentioned combined with an ap- 
parent innocence of physicians as to maxi- 
mum dosages, leads me to think that if the 
occurrences were narrated just as they 
happened, they might make an after-din- 
ner speech which would be received witli 
the well-known ''applause and roars of 
laughter." But the aforesaid occurrence 
would be only too easily traced to their 
sources, afid any jesting would smart like 
the hornet's sting. 

Aconite is a well-known poison rightly 
handled and labelled as deadly, but mapy 
physicians would be surprised to learn that 
two hundred grains of the powdered root 
liave been taken and recovered from. It is 
a drug which manifests its effects in very 
^mall doses; from the therapeutist's stand- 
point five drops, of a good preparation, 
;given in divided doses throughout a day 
are about as useful as the same amount 
^ven three times a day. For this reason 
the dose is minute and not because it is so 
very poisonous. 

Flemming*s tincture seems to be a stand- 
ard preparation, one usually considered 
very active, but an ounce of this has been 
swallowed and recovered from; yet it is 
about seven times as strong as the U. S. P. 
recommends. My opinion is that while the 
small doses in use are advisable, yet they 
may be also safely increased if the increase 
be deemed indispensable. And because a 
patient has taken a half teaspoonful (or a 
full one) is no reason for abandoning hope 
since probably no permanent evil will re- 
sult unless it comes from the "scare" which 
seems to be the harmful but unnecessary 
accompaniment of aconite overdosage, due 
(or so I believe) to a widespread belief in 
the absolute deadliness of the drug. Thus 
upon the discovery of any mistake in which 
aconite is a factor, this erroneous belief 
causes the patient, his friends or relatives 
to be fairly palsied with fear. Usually 
nothing happens if the physician does not 
get "rattled" and push his antidotes too 
iar. 



The extremest "rattles" that I ever knew 
was one in which a mother gave her child 
a teaspoonful of furniture polish by way of 
antidote. This occurred because the label 
on the aconite bottle was the usual death's 
head, one with the word "Poison," and the 
furniture polish stood close by with the 
plain words "Not Poison" on its label. The 
dose of the aconite was to be one drop, but 
the mother put in three or four, gave it to 
the child, and realized the "awful thing 
she had done." So knowing the furniture 
polish was "not poison," she administered 
that as a corrective. 

Perhaps there would be many fatalities 
from the wide-spread domestic use of acon- 
ite were it not for the fact that the usual 
total amount of the tincture on hand is an 
ounce as a maximum, and practically but 
a fraction of this quantity is the rule, so 
that if the whole family supply were swal- 
lowed it would possibly be recovered from 
after a day's rest in a well-blanketed bed. 

The fluid extract of s^olanum carolinense 
used as a substitute for pot. bromide, has 
caused groundless scares. Its printed label, 
sometimes with skull and cross-bones, 
sometimes simply stating the dose at one 
to three minims, seems to be an error. Be- 
cause anyone familiar with the action of 
solanum would hardly give less than three 
or four teaspoonfuls a day, or even more, 
taking due precautions that the patient 
does not become intoxicated by the amount 
of alcohol which it contains. 

As to phenacetin, naturally everybody 
knows all about that, except the facts that 
it has been given in ninety-grain doses, that 
sixty grains a day have been given for two 
weeks without apparent harm, that an ounce 
and five drams in nineteen days, and one 
ounce and one dram in twelve days have 
been administered. 

Perhaps some of the profoundest alarms 
are due to the doses printed in the Phar- 
macopoeia, yet that book plainly states that 
its dosage depends on "average" dosage 
only. But one man aroused the doctor at 
night — no matter — imagine a comet in pink 
pajamas. If I narrated this incident it 
would sound like a vaudeville sketch. 
Imagine a druggist consulting the Pharma- 
copoeia on the subject of spa'rteine sulphate, 
discovering that the dose there given was 



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one-fifth of a grain, and that his relief 
clerk had put up a prescription calling for 
four grains per dose. Imagine also the re- 
morhc (or whatever it was) caused by the 
certainty that at least two doses must have 
been administered before the "mistake" was 
discovered. I forgave the poor devil every- 
thing, pink pajamas and all. Sparteine sul- 
phate in my hands is inert in any dose 
smaller than one grain and (if the patient 
has a competent nurse) the desired thera- 
peutic effect may be looked for at four 
grains or over. 

Sodse salicylate has a maximum single 
dose of sixty grains. Cotarnine phtalate 
(styptol) may be given in four grain doses 
hypodermically. Codeine has a maximum 
dosage of five grains a day. It is certainly 
perfectly clear that I do not desire to rec- 
ommend the common use of maximum dos- 
age, but I do desire to draw attention to 
facts as they are, and should this little 
paper stimulate the study of toxicology, 
ever so little, then my end will have been 
accomplished. 

128 W. 86th St., New York City. 



TONSILITIS. 

By M. a. Blanton, M.D. 

It appears to me, as the spring months 
are at hand, that a review of the etiology, 
pathology, symptoms and treatment of ton- 
silitis, is seasonable. And while this paper 
is written without any claim whatever of 
anything new or original on the subject, I 
have strictly avoided plagiarism. 

We learn that there are two varieties of 
this malady — the acute follicular tonsilitis 
and the supurative tonsilitis or quinsy. 

Various authors subdivide acute follicu- 
lar tonsilitis into lacunar, aphthous, ulcera- 
tive, herpetic and necrotic forms — classifi- 
cations that are pathological rather than 
etiological or clinical. Follicular tonsilitis 
■may present any or all of such lesions, ac- 
cording to its severity or extent, so it is at 
once confusing and undesirable to describe 
these lesions as separate diseases. 

The tonsils may be the seat of syphilitic, 
tubercular, carcinomatous — ^ulceration or 
lupus — ^and may be included in the general 



spread of the inflammation of stomatitis, 
especially mycosis; but these conditions do 
not require separate consideration. 

Acute follicular tonsilitis may be defined 
as an acute catarrhal inflammation involv- 
ing the tonsils, and characterized by local 
signs of inflammation, sore throat and a 
fever which is brief but severe. The dis- 
ease is most common in the spring and au- 
tumn months, and chiefly affects young 
adults and those in middle life. Owing to 
atrophy of the lymphatic system in the 
throat, it rarely attacks persons in old age. 

Many persons have recurrent attacks once 
or twice a year, and the disease may affect 
a household, being to some extent epidemic. 
Predisposing causes are debility, taking cold 
through exposure, indigestion, and the in- 
halation of sewer gas. Many authorities 
believe rheumatism to be a causative factor 
in producing tonsilitis. 

Scarlatina and other infections are some- 
times associated with it. No specific mi- 
crobe is found, but the many germs in the 
throat muhiplied, notably the pus-forming 
germs. Pathologically considered we find 
redness, injection and swelling of the ton- 
sils and uvula. The crypts of the tonsils 
are distended with masses of fibrin, bac- 
teria, degenerated epithelium and leuco- 
cytes. These masses have a yellow-white 
color and may be squeezed out. Usually 
they are isolated in spots, but they may ap- 
pear continuous, and being glazed with a 
thin layer of exudate, suggest diphtheria. 
Usually resolution is complete, but a few 
of the cheesy spots may remain, calcify and 
form white spots. 

Pseudo-mambranous or necrotic tonsil- 
itis is a variety in which a thin gray mem- 
brane spreads over the superficial necrosis 
of the mucosa and may extend upon the 
soft palate uvula and sometimes the pos- 
terior pharyngeal wall. Attempts to detach 
this membrane with forceps may leave a 
bleeding surface. After four or five days 
the tonsils heal and the membrane shows no 
tendency to reform. This variety is distin- 
guished from diphtheria in the membrane 
showing no tendency to reform and by the 
absence of the Klebs-Loffler bacilli. Ex- 
ceptionally this form of the disease may ap- 
pear primarily, but it is more often an ac- 
companiment of scarlatina. The first symp- 



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THE MEDICAL SUMMARY 



torn is frequently an intense muscular wear- 
iness progressing to severe aching of the 
legs and back until the patient feels as 
though he had been pounded. 

In other cases the first symptoms are a 
feeling of rawness in the throat at the pil- 
lars of the fauces, or perhaps pain on swal- 
lowing. At the onset there is a chill or 
chilliness, the tongue is heavily coated, 
there is frontal headache, and sometimes 
nausea. The temperature rises rapidly to 
104** or 105° P., with a quickened pulse. 
The temperature is irregular with morning 
remissions lasting for three or four days, 
and may end abruptly or slowly. The lym- 
phatic at the angle of the jaw are swollen 
and the neck may be quite stiff. The fever 
and pains subside within 24 to 36 hours, and 
the patient is usually well within five or six 
days. 

Local examinations show one or both 
tonsils to be red and swollen. One of the 
principal diagnostic features, however, is 
the appearance in the tonsils of isolated 
groups of yellowish spots, which vary in 
size from a pin head to a quarter of an inch 
in diameter, and which can often be re- 
moved when the surface beneath appears 
uninjured. A thin glaizy white exudate 
may cover the greater part of the tonsils, 
which however does not appear as thick 
or consist of grayish-white as does the 
diphtheritic membrane. The portion of the 
tonsils between the yellowish membrane 
looks vividly red. The inflammation is con- 
fined to the glands and generally does not 
extend beyond, as in diphtheria. 

In the majority of cases the diagnosis 
can be easily made by the gross appearances 
in the throat, but the two diseases may co- 
exist and tonsilitis with extensive exudate 
may so closely resemble diphtheria con- 
fined to the tonsils, that it is impossible to 
differentiate the two diseases without a 
bacteriological examination. 

In country practice where we are far 
removed from laboratories, it is best to err 
on the side of safely and call all suspicious 
cases of tonsilitis, diphtheria, and so treat 
them. 

Supurative tonsilitis or quinsy is an acute 
supurative inflammation of the stroma or 
peritonsilar tissue, accompanied by severe 
constitutional disturbance, local pain, swell- 



ing of one or both sides of the throat and 
rupture of a tonsilar abscess. 

The etiology is much the same as folli- 
cular tonsilitis. The pathology is similar 
except the inflammation extends much 
deeper, invading the stroma with purulent 
infiltration. On the whole the clinical pic- 
ture is that of severe follicular tonsilitis, 
but the patient is much more ill and the 
local symptoms are more severe and dis- 
tressing. On the second or third day fluc- 
tuation may be determined in the tonsils, 
and usually by the fifth or sixth day the 
abscess ruptures spontaneously, if not op- 
ened earlier. 

A condition of advanced septicemia may 
occur in cases in which the pus is allowed 
to burrow, although the tendency is ta 
spontaneous recovery. This variety is dis- 
tinguished from follicular tonsilitis by the 
greater severity of the local symptoms. 
The patient can scarcely swallow or open 
his mouth. The tonsil is greatly swollen, 
and if the finger can be passed to it a sense 
of fluctuation is obtained which is highly 
diagnostic. 

In the treatment of the follicular variety, 
it is necessary to isolate the patient, espec- 
ially from children, as the disease appears 
at times to be communicable. During the 
attack the patient should remain in bed, 
and pounded ice mixed with linseed meal 
should be placed in a container and applied 
to the throat. If ice be not obtainable, 
cloths should be wrung out of cold water 
and applied to the throat with frequent 
changes. The scruples of the laity largely 
prohibit this part of the treatment, so the 
ice pack and cold water is practically use- 
less outside the hospital. 

Peroxide of hydrogen diluted with six 
parts of water should be used as a spray 
once in two hours in alternation with a 
gargle, composed of chlorate of potassium, 
2 drams; glycerin, one-half ounce, and 
water to make six ounces. At the onset 
five to ten grains of phenacetin should be 
given to relieve the muscle pains and re- 
duce the fever. To a child it is better to 
use aconitine for this purpose, according to 
Shaller's rule. Perric chloride should be 
given in fifteen to twenty drop doses every 
three or four hours in little glycerin during 
convalescence. Quinine, salol and benzoate 



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sodium each have their places. The bow- 
els should always be cleansed by a purge 
and rendered as nearly aseptic as possible 
by the use of salol or the combined sulpho- 
carbolates. 

If there is a probability of a mixed ton- 
sil-diphtheritic infection, an early injec- 
tion of antitoxin should be used. Suppura- 
tive tonsilitis demands the same treatment 
in the main as the follicular variety. How- 
ever, hot applications to the throat seem to 
do better than cold. An early incision of 
the tonsils is demanded. 

Baileyton, Tenn. 



THERMO-THERAPY (DRY HOT AIR). 
By H. J. Chapman, M,D. 

There is no single therapeutic agent cap- 
able of more good, properly used, than dry 
hot air. Nearly every doctor to-day pos- 
sesses some knowledge of its therapeutic 
value, yet there are very few making daily 
use of it. 

There is very little danger in its applica- 
tion; in fact, none outside of a few slight 
bums, that heal in a few days without the 
slightest attention being necessarily paid to 
them, nothing further being required than 
to keep dirt and filth away from them. 

A safe way to begin the practice of hot 
air therapy, after installing the necessary 
instruments, is to make a practical applica- 
tion of the different treatments one pro- 
poses to give, and in this way one sooner 
becomes perfectly familiar with all the 
details, and is less liable to carry a treat- 
ment too far. 

It seems to me that in cold weather I 
have noticed that patients will take a high- 
er temperature than they are willing to 
stand on a hot summer day. I have never 
noticed that any writer has mentioned this. 
I have so many times noticed it that I have 
been forced to accept it as a fact and men- 
tion it at this time. 

I have just recently installed a Betz dry 
hot air body apparatus for treating the en- 
tire body. I have for several years been 
using the smaller hot air apparatus put out 
by the Betz firm for the treatment of the 



extremities and any part of the body, and 
met with such singular success that I feel 
it my duty to narrate a few of the cases 
that this treatment is specially adapted to; 
in fact, there is no diseased condition that 
can not be benefited in some way by the 
proper application of dry heat. The first 
thing that nature does to restore when any 
serious trouble occurs is to increase the 
temperature by bringing on a fever. As I 
started to say above, one of the best ways 
to become proficient in the hot air treat- 
ment is to make yourself the patient and 
take some treatments yourself. They will 
do you no harm, if nothing ails you, and 
you in this way can speak from experience. 

I made a public demonstration before a 
number of patients on myself, with the 
body apparatus, as soon as I received it, 
and I have never felt finer in my life since. 
I remained in the machine the first time 
one hour and thirty-five minutes at a tem- 
perature of 290 degrees F., and the second 
time one hour and twenty minutes at a tem- 
perature of 315 degrees F. I sweat out 3^ 
lbs. each time, so that you see it had some 
effect on me. 

In the latter part of June, 1910, 2^Iiss X. 
M., of Illinois, came to me through the so- 
licitation of some friends she was visiting. 
She was (yj years of age, frail woman, 
weight about 95 pounds. In giving me the 
history of her case, she had got ivy poison- 
ing hunting blackberries four years pre- 
vious, which left a running sore extending 
all the way around the ankle. She went to 
her family doctor, who treated it for some 
four months, with no success, and the leg 
almost to the knee was eczematous. She 
then tried another doctor, who told her the 
sore needed a cauterizing medicine that 
would eat out the diseased surface before 
the sore could heal, and that she applied 
the medicine until the loss of blood it oc- 
casioned became alarming. 

The next doctor told her that a cure was 
impossible, and that she need not hope for 
a cure; amputation of the limb would be 
the only relief, and she added, "Doctor, I 
believe this man was honest and told me the 
truth. I have made up my mind to have 
it amputated; the awful suffering that I 
go through and the sleep that I lose with it 
has almost distracted me." I told her what 



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I believe that hot air treatment would do 
for her, and she said, "Doctor, don't talk 
that way; I don't believe one word you 
say." "Then why did you come to me?" 
"To please the folks I am visiting." 

This was on Monday morning, and I had 
made arrangements to start for Chicago on 
Saturday evening to take some post-gradu- 
ate work, and explained this to her, but 
told her that would be ample time to re- 
lieve her and that should she need some 
more treatments, I could give them on my 
return. I gave her a treatment in the Betz 
arm and leg apparati|s at a temperature of 
450 for one hour and twenty minutes, and 
told her to return on the following day, 
but she could not do this on account the 
folks she was staying with could not bring 
her, but came in the day after, the most 
delighted woman I ever saw. The first 
word she said was that she knew that I 
could cure that just as I said I could; that 
she had slept soundly both nights she had 
been away, and that the burning and itch- 
ing had hardly bothered her at all. The 
medicine which I gave her, an ointment, 
consisted of: 

}ji Spts. camphor Jiij. 

Tr. iodine 3iij. 

Glycerin 5J- 

M. 

It relieved the itchirg perfectly. When- 
ever she felt any itching she applied the 
medicine instead of irritating it by rubbing 
or scratching it, but she had not been do- 
ing anything of this sort, as she had been 
cautioned against it before. She took other 
treatments on Thursday and Friday, when 
the sore was nearly healed. 

She was among my first callers two 
months later on my return from Chicago, 
and was in the best health she had been in 
for years. A dark colored skin extending 
around the ankle about four inches wide, 
and causing her no pain or inconvenience, 
was all that remained of her former trou- 
ble, and her body weight had increased to 
130 pounds. 

One more case, Mrs. Nettie M., of Lo- 
gan, Kans., came to me with a lump in the 
right breast, that had been there for sev- 
eral years, and through the advice of a 
lady friend had been let severely alone. 



This was in April, 19 10, but lately it had 
begun to inflame and gave her considerable 
pain. I never saw a woman that was in 
greater agony over her condition, made 
worse by the gloomy pictures held out to 
her by her lady friend, whose mother had 
died of cancer of the breast. 

On eamination I found a soft spot in the 
center of the lump in the breast, and ad- 
vised her to let me lance it, which almost 
took her off her feet, as her friend had 
strictly forbidden any cutting. I put the 
proposition up to her if she wanted her 
friend or me to manage her case, when she 
decided it would be more sensible for me 
to. I lanced the breast and got about one 
dram of pus, sponged the breast off witli 
alcohol, after washing out the cavity well 
with peroxide; put on the necessary wrap- 
pings, and applied dry hot air for one hour 
at a temperature of 440 degrees F. She 
remained over night, and the next morn- 
ing the gathering in the breast was less 
than one-fifth the size it was the night be- 
fore. Upon removing the crust of blood 
that closed the opening, I found about two 
drops of bloody water. I prepared the 
breast the same as the night before and 
repeated the hot air treatment for the same 
length of time at the same temperature. 

I examined the breast again In about 
three weeks, and could feel no bunch or 
tumor, and the mark of the knife was bare- 
ly discemable. She has remained in per- 
fect health ever since, and the man that 
could convince that woman there was noth- 
ing in hot air therapy would be going some. 

Let me say in conclusion that while one 
can do such things as I have narrated with 
hot air, a man can have failure and get 
into trouble with it if he does not thorough- 
ly understand its technique and practical 
experience is worth all the rest. A person 
with a sluggish circulation can not stand 
these high amounts of heat so readily as 
the young, and this occurs in both the 
young and old. 330 degrees is high enough 
to get the best of results in most cases, but 
anything under this is likely to not have a 
satisfactory effect. And last, but not least, 
the selection of hot air apparatus is, I be- 
lieve, the most important. I have no in- 
strument maker to boost or tear down, and 
I have tried several different makes, but 



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those manufactured by the Betz is the only 
one that meets every requirement and has 
given me entire satisfaction. I say this be< 
cause I wasted some money in finding it out. 
Speed, Kansas. 



THE MORPHINE HABIT AND ITS CAUSE. 
By C. E. Patterson, M.D. 

Having been in the work of curing mor- 
phine and liquor habits now for eighteen 
years, it seems my experience should be of 
some benefit to the profession, if not to 
the public. Considering what the medical 
profession in general say of a cure for 
either drug or liquor habits, it is almost 
like crucifying yourself to as much as say 
that you treat such cases, but when the great 
majority of my cases come from the medi- 
cal profession, and medical nurses, why 
they should say as they do of a cure for 
these habits I cannot conceive. Perhaps 
because ©ccasionally a cured patient will 
relapse, they will cling to such an opinion, 
and emphasize it through the journals of 
the failures of such treatments, and I am 
sorry to say many journals will accept an 
article of condemnation of a thing at any 
and all times without even an investigation 
of the facts; while to the contrary no mat- 
ter how successful you are, not an article 
will they accept telling of your success, 
even were it to be the means of saving all 
the doctors there are in the medical pro- 
fession, who are at present addicted to the 
use of some drug, and they are no small 
number either, and I know whereof I 
speak. And then I would ask, what is the 
disease that any doctor treats, that he can 
make them so immune from it, that the 
same cause will not produce the same ef- 
fect again? Vaccination comes the near- 
est ot it of anything I know, and yet, when 
Jenner made the assertion that such was 
a fact, the medical profession was almost 
ready to burn him at the stake, without 
even investigating what he said, and let 
many die before they would accept his dis- 
covery, for fear their fixed opinions would 
be knocked flat. 

Now. in regard to the treatment of drug 
cases, if you would stop the effect, you 



must first search for the cause. All will 
say in one voice, why it is the drug they 
use which is the cause. But I say. No. 
Where is the doctor who knows so little 
but that knows opiates, liquor, chloral and 
in fact any stimulant will, if used for a 
length of time, so fasten itself to him that 
he cannot free himself from it without 
help. Now what was the primary cause? 
My answer is, ignorance. Lack of under- 
standing that any doctor should have. 
Then what has got to be one of the first 
things in a treatment to cure such a case, 
in order that it may remain cured, to get 
rid of the drug, or to get him to under- 
stand, there was something lacking in his 
brain make-up? 

Some men can only profit by their own 
experience, and have really got to have the 
experience before they can know, and like 
some children, have to be burnt several 
times before they can realize a stove is 
hot, and will burn, and while fire only 
burns the flesh, drugs are fire that burn the 
very soul, and yet doctors even will re- 
lapse. What would you call a child that 
would insist on repeating his burns on the 
stove? Could a doctor be exonerated from 
the name any more than the child? 

Now, with all cases whom I can succeed 
in waking that inner consciousness to a 
sense of understanding I can cure. But to 
those cases who are clothed so thickly with 
material mire, they will relapse. I get 
them so they do not have to take drugs, 
but the primary cause still remains; call it 
what you will, aside from the drug, but 
not that, as the drug is now gone and the 
eflFects removed that made the call for it. 

And now as regards the laity. If doc- 
tors are in the majority as drug takers, 
God pity the people, who are obliged to 
call upon them for advice in regard to 
their many ills. I see that the Internation- 
al conference at The Hague are trying to 
start a campaign against opium using. As 
one of the means of prevention of the habit 
they recommend the prohibition of the use 
of opium, except under medical supervis- 
ion. Now, in eighteen years' experience, I 
do not recall a single case that did not 
start originally with some doctor's pre- 
scription. And among the laity my re- 
lapses have been caused by some doctor 



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THE MEDICAL SUMMARi^ 



giving codeine or heroin, being so defi- 
cient in understanding as to think that if a 
patient did not know he was taking an 
opiate he would not become addicted to it; 
and with so little knowledge as to tell his 
patients that codeine or heroin would not 
produce a drug habit. 

Look over your medical journals at the 
favorite prescriptions of some of the so- 
called noted physicians, and see how many 
cough syrups there are prescribed that do 
not contain heroin or paregoric or co- 
deine. Go to your noted specialists on the 
nose and throat, and get a prescription and, 
how many will not contain cocaine or 
something of its nature? 

Now, I ask, is Burney's snuff, full of 
cocaine, any worse to produce a habit, than 
some noted physician's prescription con- 
taining the same ? Is a home cure for drug 
habit, loaded with morphine (and I assure 
you my sympathies are not with any such 
a cure) any worse than a cough syrup 
loaded with heroin or codeine? 

And now I would ask you, what are you 
going to do about it? No teachings in 
your medical college telling one how to 
get rid of it, should he have been so un- 
fortunate as to have contracted a habit. 
No teachings telling you how to free a pa- 
tient, should you have been careless en- 
ough to have been the cause of one's down- 
fall. The medical profession in general 
standing back without even an investiga- 
tion and condemning every one who is 
actually having success, judging merely by 
results obtained by unscrupulous brutes in 
the form of men, who would claim to cure 
you at your own home, or in three days 
at their place, etc., etc., their only aim be- 
ing to get your money; and I am sorry to 
say such tempting cures will get loo to 
I of any legitimate cure, who is working 
really for the benefit of humanity. You 
place a straight legitimate adv. in a medi- 
cal journal, telling the exact plan of your 
treatment and exact truth; there will an- 
other appear right by the side of it, an 
absolute lie from start to finish, but word- 
ed so nicely that your adv. is only a profit 
to the journal. None to you. And still 
the question remains unanswered, what are 
you going to do about it? 

I sometimes get so disgusted with the 



ways of the world that I feel like throwing 
up the work I have been engaged in of 
saving lost souls, as a result of habits, for 
now eighteen years, and going forth as a 
missionary, teaching the people laws of 
prevention instead of cure. And the ques- 
tion only arises, would it not be better to 
prevent than to cure? I think the world 
is coming into that thought at the present 
time. And if I have in this short article 
thrown out any suggestions as to preven- 
tion, I feel I am repaid for my trouble of 
writing. And should I have been the 
means in this article of helping any human 
soul, I know I will receive in some way, 
something somewhere. For if you would 
give you must receive. 
Grand Rapids, Mich. 



EPIDEMIC CEREBRO-SPINAL MENIN- 
GITIS. 

By W. M. Alter, M.D. 

I see some health officer writing of spinal 
meningitis as likely to become epidemic in 
this State. The good doctor must have 
reference to the cerebro-spinal meningitis. 
I believe we should when writing for the 
public press, in order to either instruct or 
warn the profession or the people, observe 
our distinctive nomenclature in order that 
the object of our writing may be duly ap- 
preciated. 

Hoping that what I say upon the subject 
may not be offensive to any brother in the 
profession, I wish to call the attention of 
the readers of the Medical Summary to 
the fact, that when we say spinal menin- 
gitis it refers to what is called also lepto 
meningitis, which is a distinct pathologic 
condition from cerebro-spinal meningitis, 
or spotted fever, and this is the disease 
which has appeared in different epidemics 
for the last one hundred and seven years. 

I do not wish to criticise the profession 
unjustly, in discussing this, but hope to be 
accorded the credit of being sincere when 
I decline to adopt the views of many of 
my brethren in regard to therapeutics in 
this dread disease. This grave pathologic 
condition was identified or distinguished or 
isolated from other pathologic phenomena 
having or showing similar symptoms in 



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1805, and has therefore been before the 
profession for therapeutic observations for 
over a century, and I must say no specific 
agent or methods have been discovered by 
our profession during this long period. 

Its etiology is supposed by those who be- 
lieve in its bacteriologic origin that the 
germ meningococcus is the pathogenic fac- 
tor in this effection, and therefore proceed 
to treat it by injecting an antitoxin into 
the spine. They claim this method destroys 
the meningococcus, and having done this 
removes lesions, and thus brings about a 
cure, or more properly enables the vital 
powers to resume their proper office in re- 
storing normal conditions. Those scientists 
bring to view statistics deduced from ob- 
servation and further claim that under this 
plan of treatment this disease has lost a 
large per cent, of its mortality. 

I am not prepared to adopt this theory 
and method as sound and safe. I look upon 
this as I am compelled to do on many other 
so-called germ diseases, that the germ is 
evidence of the previous action of patho- 
genic causes, and which causes places the 
patient in a condition for the evolution of 
the coccus, and this germ and others 
brought to view by the microscope, and iso- 
lated by bacteriologists are evidences of 
disturbed metabolism, and I consider this 
as strong evidence of the eflFort of the 
vismedicatrix natura to maintain the nor- 
mal physiologic integrity against a primary 
pathogenic depression of vital energy. 

In taking this view of this grave disease 
I conclude that to inject antitoxin into the 
spine is very unscientific as a cure, though 
I think it scientifically dangerous, and that 
the physician who practices it can never 
know whether his patient died on account 
of the treatment, or recovered in spite of 
it, and such may be said forms the element 
of doubt concerning all statistical evidence 
in favor of any methods of treatment. The 
reasons I have assigned here are not all the 
objections there is; the promotion of the 
producers of antitoxin who are enabled to 
impoverish the poor sufferer who under 
fear of the dread contagion as he is taught 
to believe, will sacrifice all he has to pro- 
cure immunity from so dreaded a disease; 
and this is not all physicians who adopt this 
which I shall term scientific ignorance, be- 



lieve with all their heart that they are do- 
ing the only thing which offers life to their 
stricken victims. 

These are not the only lines in which 
schools teach their disciples things of which 
they are ignorant themselves, and thus it is 
that they may be thoroughly educated 
wrong, spending much time and means in 
learning many things which lack the truth 
of being scientific. 

I believe the disease under discussion is 
infectious, but I doubt its contagious prop- 
erties; therefore were I a health officer, as 
a means of prophylaxis and prevention I 
should strike from the public mind the hor- 
ror conveyed by this gloomy word contag- 
ion, and as a physician or officer I would 
let the people know that this disease is not 
nearly so virulent as it formerly was, and 
that more recover under all forms of treat- 
ment than in former times. I advocate the 
theory that the disease is produced by ther- 
mal and barometric conditions, together 
with insanitary conditions and other sur- 
roundings which deplete the vital powers. 
Fear has a great deal to do with the inau- 
guration of the epidemic drama of this as 
well as other diseases. I am pleased, how- 
ever, to be able to enable the patient to re- 
cover. This disease is an inflammation of 
the membranes which invest or cover the 
brain and spinal cord, and like any other 
inflammation has a preceding conjestive 
stage, and when a case is seen in that stage 
it can often be aborted by proper treatment. 

Belladonna is a favorite drug here with 
me, or atropine or hyoscyamine hypoder- 
mically used. Other drugs I admire when 
indicated morphine and atropine combined; 
gelsemium is an excellent drug when its 
use is indicated, and aconite and veratrum 
are useful in all inflammatory conditions 
when pathologically called for. Bryonia 
is another drug I consider useful. A 
good means is also friction to the spine, and 
the scarification and cupping in the cervical 
region as near the atloid region as possible. 
A blister in that region may be useful. 
There are also many other things the in- 
telligent physician can do to mitigate the 
sufferings of the patient and enable him to 
return to health. 

I will add here that the cinchona alka- 
loids are useful in subjects infected with 



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THE MEDICAL SUMMARY 



malaria. I prefer the cinchonidine salicy- 
late combined with caffeine alkaloid. 

In conclusion, I will submit the follow- 
ing as prophylactic measures. The moder- 
ate saturation of the system with calcium 
sulphide, or this: 

5^ Cinchona, (Normal Tct. or 

Sp. Med.) 5iij 

Anemopsis (Normal Tct. or Sp. 

Med.) 5iiiss. 

Saw palmetto (Normal Tct. or 

Sp. Med.) 3vj 

Macrotys (Normal Tct. or Sp. 

Med.) 5ij 

Coca (Normal Tct. or Sp. 

Med.) 5iij 

Avena sativa (Normal Tct. or 

Sp. Med.) 5v 

Fid. ext. Populus Monilifera, 

q.s. 5viij. 

M. Sig. — A teaspoonful one hour after 
morning and noon meals, and two at bed- 
time. The dosage given in my prescription 
is for adults and may be decreased for chil- 
dren to suit age. 

England, Ark. 



"PREDISPOSING AFFINITY." 

By J. P. Dickson, M.D. 

The words seem to be a mixture of sci- 
ences. That is what we have, and so it is 
expected they will be appreciated. It is 
conditions precedent along the line of phys- 
iological chemistry and physiological path- 
ology that is lacking in both the study of 
bacterial poisons and zymotic diseases, al- 
beit a scientific treatise on either might 
guardedly assume the reader would be fa- 
miliar with metabolism and cachexia. The 
words imply a departure from the normal, 
and so are quoted in order that the normal 
may first be considered, and considered also 
as first in importance — the dominent issue. 

The debate as to whether human diet is 
normally vegetarian or fleshy goes merrily 
on. I have seen no reference to the state- 
ment of Parkes that a few days of ex- 
clusive meat diet will produce fever, but 
attempt has been made to trace fever to 
biology, to autotoxicosis and to chemistry, 
i. e.j physical chemistry. 



In a scorbutic state the body is consider- 
ed almost literally '*more dead than alive." 
In any dietetic state it may be some dead — 
a prey to some sort of other life or merely 
a dainty morsel for some scavenger here 
or there. Both lack of meat and a meat 
diet has been shown to augment resistence 
if not to afford immunity, but in both cases 
the change is both prompt and decisive, so 
that so far one can safely draw a conclu- 
sion that the human body is quite sensitive 
to change, and that we as yet dare not be 
too exclusive in any diet. For long it has 
been a rule to watch for one of full habit 
to have this or that — much depending on 
the habit, and we yet knowing very little. 
So we can afford as yet to ignore biology 
in a search for cause. 

It may be the body can ripen and by its 
own ferments foredo itself, but one again 
need not so pronounce so long as his mind 
is mistrustful as to the mechanical, physi- 
cal or chemical effect of some habit of ex- 
cess in a vain attempt to get the needed 
mixture. 

Again, autolysis may be improbable if a 
lack is a cause, rather than an excess per 
se, all of which goes to show the f>hysiologi- 
cal and economic necessity we are under 
for further studies of the chemistry of 
foods. 

My neighbor has imperically put the po- 
tato in the fruit class, and it may as well 
stay as the tomato, or even may better stay, 
for in most fruits now commercially sup- 
plied it can readily be seen that it is not 
alone sugar, but alkaline and earthy salts, 
and not free acids that instinctively are 
being used even if not well supplied by 
growers and manufacturers. But the po- 
tato has its limits. It is not solely its tough 
cellulose, but its undue and strong salts that 
make one tired of it. Many fruits when 
strong are diluted with steamed rice, the 
needed fat being added by way of tallow, 
rather than as in hash by fatty scraps so 
handled as to have and retain quite a lot 
of fatty and volatile acids. One of the 
salts, malate of ammonia, (asparagin) its 
product, may very easily be antizomotic by 
reason of an atom of oxygen in malic acid 
being set free and a succinate resultiijg, but 
this salt and asparagin may lose ammonia 
and become an acid salt not well adapted 



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for continuous use, as the acid salts may 
cause oxaJuria. Also, there is in steamed 
rise either a sugar or modified starch that 
easily undergoes the lactic fermentation so 
that it is as easy as with milk products to 
demonstrate rheumatism, while moderation 
may also demonstrate a wide adaptability 
to industrial conditions. The per cent, of 
water would be such as to have a pure sup- 
ply not too hot nor too cold. 

We have in diet, as in clothing, housing, 
bathing, ventilating and warming or cool- 
ing, a running fight to make to keep clear 
of fatty acids, very likely to be present in 
aged meats. It is demonstrated also that in 
old meat, whether from or with putrefac- 
tion, there is present a narcotic (unnamed) 
soluble in alcohol (Panum). It appears on 
the block and quickest in such cuts as flank 
(fasciae). It is not as volatile as fatty 
acids, and so is in soup made from or with 
meat. Boiling in water does not free the 
meat of Panum's narcotic, and it may de- 
velop from long boiling or keeping of boil- 
ed meat or in the alimentary canal. If 
truly alkaloidal it may be antacid and may 
be so appreciated. 

A careful study of Parkes makes one 
suspect that he secretly had no faith in free 
vegetable acids as beneficial for some time 
in scurvy. At least he urges trial of the 
salts of the vegetable acids. The potato 
has likely more citrate than has fresh milk, 
while the milk has far more mucin and 
proteid than its salts will aid in assimilat- 
ing. So it has seemed to keep many pa- 
tients down with fever and catarrh un- 
known to all until the patients rebel or 
steal other food or listen to some outsider. 
In the meantime the patient is predisposed 
a!!d the name of his dread bacterial affinity 
is Dread Legion. Temporarily the free 
acids may shift his alkalies or bases from 
one use to another more pressing, while 
this process is leaving his system loaded 
with suboxidation products. 

In physical chemistry one has to note an 
attempt to set up excess of lime or mag- 
nesia as a cause of vaso-constriction or of 
paralysis. It looks more like the work of 
a special poison, for Dalton saw no excess 
of lime in the approved diet of his day, 
while he noted a very considerable differ- 
ence in the amount of magnesium in nerves 



and muscles as compared to bones and 
other tissues, while the patients who have 
nerve and muscle pains are the ones clearly 
benefitted by heavy or light magnesia or by 
gelsemium, which has some magnesia. 
Buckwheat draws magnesia from soil very 
noticeably (Wood), but it has been noted 
in no food product so well as in scorched 
cactus, a cattle food of Texas, that is laxa- 
tive but valuable. 

I put more thought to getting proper aids 
to assimilation than to fear of an excess 
when no aid is supplied. I think buck- 
wheat might well dilute potato and assist 
in fatty digestion as antacid. 

1228 Park St., Keokuk, Iowa. 



• A BIENTAL AND DRUG APPLICATION. 

By Elias Wildman, M.D., Ph.G. 

I notice an article on "Newer Psychol- 
ogy." It is a subject for deep considera- 
tion. Some laugh at it. Yet it has a strong 
bearing on our work in every-day life. It 
is a difficult matter to draw the line of de- 
marcation between normal and abnormal 
thoughts, such impre§sive, or inner con- 
trolling thoughts that through the sympa- 
thetic nerve produce organic action of an 
abnormal kind. Will drugs, then, make 
one think less of those conditions which 
surround them? I believe a physician 
should know sufficient of psychology to 
lead the mind of his patients, and by an 
earnest effort lead them over the darker 
moments of life's journey. Often a few 
kind words are of more use than all the 
drugs — if those words are given properly 
to the patient. 

The sound of a family physician's foot- 
steps in entering the house will often cause 
a better condition of pulse, respiration, etc. 
There is an influence on the mind of the 
patient, and the doctor must be ready to 
treat his patients and give them what they 
need, be it psychological treatment by 
words, hypnotic or suggestive action, but 
they always expect medicine. Give such, 
even a placebo. We are living in an age 
of rush and hurry. Everyone is in that 
rush to get ahead. If a man earns $20 a 



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THE MEDICAL SUMMARY 



week, he often lives up to $30; he has a 
balance due in the grocery, the meat store, 
etc. The physician is the last to get his 
bill. Doctor is considered an old reliable; 
useful in the hour of trouble, he can wait 
for his money. You all understand. 

Now, when we meditate on this question, 
our patients are living at this pace, and we 
as humble servants, how shall we manage 
them? The advertising men, specialists, 
will get many and large fees, while they 
leave their bills to us unpaid. If one op- 
eration by a specialist does not conquer, 
why then have another. Keep it up, as 
long as your pocketbook can stand the pres- 
sure — after which the specialists, etc., will 
forget you. Now, I am coming to facts in 
medical practice. Would it not be better 
for each family doctor to study the pecul- 
iarities of his patients, guide them by men- 
tal treatment as well as drugs, and not 
wait until they are called insane or cranks? 
Do it before. How often physicians dis- 
agree in diagnosis, an operation is per- 
formed, patient dies. The atopsy shows no 
severe organic trouble. Therefore do as 
some of the writers for your journal sug- 
gest — study chronic disease, study psychol- 
ogy or the effects of the mind, or thoughts 
upon the bodily functions — and do your 
best, and if you do so, you will be a God- 
send to humanity. 

In the selection of drugs, do not con- 
demn a drug if it does not always give the 
desired results, for you may have used an 
impure article. For instance, to explain 
myself, a medicine derived from a vege- 
table or herb, must be made from that 
vegetable or herb when it contains that ac- 
tive principle; at a certain season of the 
year it should be gathered and prepared. 
But we do not always get such. This is 
why there is so much discord in therapeu- 
tical science. One doctor uses a prepara- 
tion and gets good results; another does 
not. A doctor uses a drug and for a while 
gets good results; then it fails him. Why? 
If it was good once, can it not be the same 
afterwards? We must take time to look 
deeply into these matters. 

I believe if the family physician would 
study his cases with chronic diseases care- 
fully and treat with mental suggestion, as 
well as with proper, pure drugs, his chances 



of saving and prolonging life would be bet- 
ter than hastily cutting into the patient to 
satisfy a question of diagnosis, regardless 
of life. 

A case for instance: A man of 50 years 
of age, general run down condition, in bus- 
iness and speculation, carrying heavy men- 
tal strain, showed all indication of severe 
stomach trouble. One physician said chron- 
ic gastritis, another ulceration, another cir- 
rhosis, and another gall-stones. He was 
told that he must be operated on, the only 
means of prolonging life. He consented; 
was buried a short time after operation. 
The condition found in operation was ulcer 
of stomach; he was broken down by over- 
taxation of his vital powers. He tried to 
do more physical and mental work than 
, one mind could do. 

Now, can any physician do any worse 
than that in the treatment by drugs? Can 
you not all look about you and see that we 
need to study the influence of the mind 
upon the body and its exhausting influence 
to the vital functions opening the way to 
serious changes in our organic structures 
by irregular action? 

Christian Science gets its hold by guid- 
ing the mind away from depressing influ- 
ences, such as to interfere with nature's 
laws. Why cannot physicians do likewise? 
There are more than drugs and knives to 
be used in the practice of medicine. It is 
the physician's duty to either cure or alle- 
viate the sufferings of his patient; use 
drugs, electricity or any other method, but 
give results. Do not allow them to go 
elsewhere. 

If you need treatment to the mind, give 
it. Do not ridicule ideas of the patient as 
silly, for they are real to them. And those 
silly ideas influence their brain and diges- 
tive functions, and as soon as the digestive 
functions are impaired, the nourishment to 
the machinery of life stops, and the whole 
intestinal tract is filled with toxic material. 
Mental emotions act upon the secretions of 
the digestive organs. Some patients will 
tell you after a day or so of mental anxiety 
that they will have gastric or intestinal dis- 
tress, followed by a looseness of bowels, 
stools frequent, pain and general depres- 
sion. Will drugs cure this patient? He is 
a robust man, looks the picture of health. 



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SI 



Here is where our psychological advice 
comes in te reason with him. Call his at- 
tention to the cause and its effects. 

Some time ago a noted divine began to 
treat patients by mental or suggestive treat- 
ment. He accomplished remarkable results 
where physicians failed. Why did those 
physicians fail? Because they went along 
in a careless manner and did not consider 
the mind had an influence over the bodily 
functions. Whereas, the reverend looked 
closely to that point in his psychological 
study. There are no secrets about it. It is 
plain and simple, if one will only get down 
to it 

Several years ago there came to Phila- 
delphia a couple of advertising so-called 
"professors.'' I as one possessed of curi- 
osity, seeing their advs. in the daily papers, 
went to the Odd Fellows Hall to a daily 
lecture and illustration of their* methods. 
I found a nice large hall, rather peculiar 
set of people, and the professor gave a 
reasonable lecture on the uncertainty of 
drugs, talked about 30 minutes, and then 
invited up those who needed curing by his 
'^magnetic'* method. There was a rush for 
the stage, and the professor, but I noticed 
he only allowed certain ones to come up. 
One woman had a severe headache. The 
professor stood first back of her and made 
gentle passes over forehead, and I noticed 
his tone of voice was very suggestive, such 
as, you are getting better, it will soon 
leave you. She began to cry, when he 
stepped to the front, and kindly said, "Ma- 
dam, you should not cry, but feel glad, for 
you will soon be cured." Then she smiled 
at him, and he had everything his own 
way. She left the stage smiling and happy. 
People were ready to spend their last dol- 
lar on the great professor. 

Again I picked up a Philadelphia paper 
and saw where the spiritualists would have 
healing mediums at a day and hour, so I 
went to see that performance. We gath- 
ered together, placed in a circle the in- 
valids sat in two chairs in center of circle. 
The mediums (who sat in the circle) after 
all singing several hymns, came forth, and 
by hypnotic passes of hands over the in- 
valids, treated them. After the perform- 
ance I went to a lady (patient) and asked 
her if she noticed anv relief from this 



treatment. She said, **Yes, I go to that 
woman three times a week for ovarian dis- 
ease, and I always feel better." I noticed 
the spiritual medium hunted for her ovar- 
ian region. Now, that woman would go 
to a humbug, spend her money, and no 
doubt cheat the honest doctor out of his 
bill! 

If the doctor had studied human nature, 
he might have collected his bill, and saved 
her from these human sharks. This wo- 
man was one whom any physician would 
say by the face and general condition of 
her nourished body, that the trouble was 
more mental than physical. 

Another time I passed by a place on 
North Ninth street where a religious sect 
cured by the laying on of hands and pray- 
er, so I thought best to take that in along 
with the others. It was the same old style. 
Creating a deep impression by singing, etc., 
on the mind, and what we call hypnotic 
passes of the hands. But they had a piano 
and organ there, and they used the piano, 
played by a yourfg woman. I asked one 
of the brethren why they did not use the 
organ for sacred music. In return, I was 
told the sister had a weak back and could 
not work the petals. So you see there is 
always a hold-back. 

This subject may seem ridiculous, yet we 
see just such in every-day life. Meet con- 
ditions as you find them. Fancy theories 
will not carry us through. We need re- 
liable practical points to work on, and the 
Medical Summary will give them to you. 

Haddon Heights, N. J. 



CROUP. 

When the symptoms are urgent, dip a 
towel in very cold water, wring out and 
bind around the neck, covering same with 
a dry towel. Follow with emetics until re- 
laxation follows. In the absence of ipecac 
give salt water or mustard water. An old 
and serviceable remedy is a mixture of 
alum and honey. Its administration is usu- 
ally followed by emesis. As a folIow-u|> 
treatment give calomel and iodized lime — 
calcidin. 



Look for diabetes where wounds are 
very slow in healing. 



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Uader ifab head tra ttuimwr to pnmmt m Cos 
mmft nfiabla toaoai, dua nviag oar le xfa w ouich 






d Siwiry fli Praclicil MeffioM. <ka%m horn tfaa beil And 
k wiHMiwng oal (fom dia diaff, meiicAl sain* d rati tmIm. 



AGREEABLE DISINFECTANT. 



The following mixture forms a thick 
cream, a small quantity of which, poured 
on a plate, soon diffuses an agreeable odor 
throughout the apartment, acting at the 
same time as an effective disinfectant: 

Camphor 20 parts. 

Chloride of lime 50 parts. 

Alcohol 50 parts. 

Water 58 parts. 

Oil of eucalyptus i part. 

Oil of cloves I part. 

The ingredients are to be mixed secun- 
dum art em. 



OPERATION FOR HEMORRHOIDS. 

Dr. C. A. Bucklin describes his method 
of operating on hemorrhoids as follows: 
The patient having been prepared for this 
operation by taking upon retiring on the 
previous night the necessary cathartic is 
anesthetized to the state of muscular relax- 
ation. The greased blades of a bivalve 
vaginal speculum that can be forcibly dis- 
tended with a screw mechanism are in- 
stantly introduced just through both 
sphincters sufficiently to insure that they 
arc stretched when the blades are expanded. 
Five minutes are taken distending the 
blades to the proper size. The screw is 
now reversed one turn, which causes the 
f>lades to relax from their strong contact 
'with the musous membrane of the anus suf- 
ficiently to allow the speculum to be slowly 
rotated and manipulated for the purpose of 
exposing the lining of this opening for in- 
spection. Hard stumps resulting from pre- 
vious hemorrhoids are removed with the 
forceps and a knife. Other forms of this 
disease are treated with the forceps and a 
No. I catgut ligature, after which the hem- 
orrhoids are cut off outside of the ligatures ; 
or when the swellings are too numerous 
they may be treated with hypodermic in- 



jections of 30 per cent, carbolic acid in 
alcohol. The slits made in the mucous 
membrane by operating are better closed 
by stitches of No. i catgut for the purpose 
of avoiding complications. — Med. Record. 



THE VALUE OF EYE EXAMINATIONS TO 
THE GENERAL PRACTITIONER. 

Dr. C. T. Russell, Jr., of Philadelphia, 
presents the following valuable pointers in 
Ihe Dietetic Gazette: 

In this day of advanced laboratory work, 
the general practitioner, in trying to make 
a diagnosis, calls to his aid the various la- 
boratory methods, some of which are not 
positive, and often neglects or overlooks 
Nature's own laboratory — the human eye. 

The ophthalmoscopic examination is just 
as much a laboratory method as a blood 
pressure or Wassermann test, for it is by. 
comparative examinations that we are able 
to tell the normal from the pathologic. In 
other words, an eye examination materially 
aids us in making a definite diagnosis, for 
example, albuminuric retinitis is pathog- 
nomic of Bright's disease. 

It has been estimated that from seventy 
to seventy-five per cent, of systemic diseases 
show some manifestations in the eye; so we 
can readily see the advantage of an exam- 
ination of this organ. We will consider 
some of the common conditions, viz.: 

DISEASES OF CIRCULATION. 

1. Valvular disease sometiems causes re- 
tinal hemorrhage, pulsation of the retinal 
vessels. 

2. Endocarditis, embolism of the central 
artery of the retina. 

3. Arteriosclerosis, characteristic retinal 
change. 

INFECTIOUS DISEASES. 

I. Cerebral spinal meningitis causes par- 
alysis of the extrinsic muscles, ptosis, and 
abnormalities of the pupil. 



52 



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SS 



2. Diphtheria causes paralysis of accom- 
modation of external muscles, usually the 
external rectus. 

Erysipelas causes sometimes Orbital cel- 
lulitis. 

Purulent conjunctivitis and iritis are usu- 
ally caused by the gonococcus. 

Scarlet fever and measles usually start 
with a catarrhal conjunctivitis. 

Syphilis causes iritis, choroiditis, optic 
neuritis, vitreous opacities, gummata of the 
orbit and paralysis of the ocular muscles. 
Inherited, causes interstitial keratitis. 

Nephrisis may cause edema of the lids, 
chemosis of the conjunctiva, and always 
causes albuminuric retinitis. 

Whooping cough causes sub-con junctival 
hemorrhage. 

Diabetes is the etiologic factor in many 
cataract cases. 

There are numerous other instances of 
systemic diseases which may find lodgment 
in the delicate structures of the eye, but I 
think I have mentioned enough to at least 
convince anyone of the importance of ^n 
eye examination. 

The eye itself, on the other hand, is re- 
sponsible for numerous other symptoms 
located remote from its anatomic situation, 
such as errors of refraction, causing severe 
headache, migraine and backward children. 

Heterophoria or disturbance of the mus- 
cular balance sometimes produces symptoms 
of neurasthenia in otherwise healthy adults. 

Poisons not infrequently cause optic atro- 
phy ; among the more common may be clas- 
sified alcohol, tobacco, iodoform, arsenic, 
lead and shellac. 

Conclusion; A careful examination of 
the eye should be considered as one of the 
best laboratory methods at our command 
to-day, and we have not completed our case 
history satisfactorily until we have prop- 
erly interpreted the beautiful ponorama as 
seen from behind the small aperture in the 
mirrored glass. 



For ingrown toenails, make frequent ap- 
plications of Monsel's solution to the af- 
fected nail. 

A cheap and efiicient dentrifice is a mix- 
ture of precipitated chalk, powdered cas- 
tile soap and powdered orris root. 



ANTIPBRIODIC— LI1IIM£NTS» ETC. 

The following is a reliable ant^criodic;. 
one that has generally given satisfactoryr 
results in suitable cases: 

9 Strychnine sulph gjr. s&. 

Cinchonine sulph .3ivi. 

Iron sulph 5j- 

Magnesium sulph JiL. 

Sulphuric acid to solve. 

Aqua lavandula q.s.. ad 3xvJ.- 

M. Sig. — One tablespoonful three times 
a day. 

Another very similar preparation isr 

9 Chinconine sulph. • • -Si 

Magnesium sulph Jii j^ 

Iron sulph 3ii^ 

Sulphuric acid to solve, 
Spts. lavandula comp., 

q.s. ad ^xjixij, 

M. Sig. — Tablespoonful three times a day. 

HoRwiTz's Excellent Embrocatiok^ 

9 Chloroform, 

Ether, 

Spts. camphor, 

Tinct. opium aa 5i- 

Tinct. capsicum 3iv- 

M. Sig. — Apply locally. 

An Anodyne Liniment. 

The following is Dr. Gould's anodyne 
liniment : 

^ Tinct. aconite 3ss. 

Tinct. opium 5ir^ 

Tinct. arnica 5i- 

Chloroform 5i>^ 

Soap liniment q.s. ad Jtr. 

M. Sig. — ^Apply locally. 

A Penetrating Liniment. 

Dr. Henley says: The foUowii^ pene- 
trating oily liniment reduces all kinds oi 
inflammatory processes ^ 

9 Parafin oil 5*^. 

Powdered capsicum 5hr. 

Digest on sand bath and filter. To tli» 
may be added directly the following: Oil 
of wintergreen or peppermint, phenol thy- 
mol, camphor or eucalyptol, etc. 



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iwapf^liiMfMWi-Jinii I .UtM^wa«l^Upriiiiinli«JiAii 



SPASMODIC TORTICOLLIS— REPORT OF 
AN INTERESTING CASS. 

Editor Medical Summary: 

Mrs. F., American bom, age, 66, house- 
•wife, twice married, a mother of three liv- 
ing children. Labors normal, menstruation 
always normal, menopause at 47 normal. 
Has never been sick, but has always been 
of a nervous temperament. Heart action 
So, normal in sound, but weak and irregu- 
lar, radial artery hard, non-compressible, 
urine 1020 to 1030 traces of albumin, no 
sugar. Granular and hyalin casts present. 

About four years ago she noticed a 
slight twitching or contraction of the mus- 
■cles of the left ^ide of the neck, accom- 
panied by slight pains and tenderness, last- 
ing for a few hours to two or three days 
at a time, when it would gradually disap- 
pear, but it would return at varying inter- 
vals from one week to one or two months, 
and always worse whenever she was feel- 
ing tired out and nervous or worried. 

There has been a steady increase in both 
frequency and severity until within the 
past two years she has been almost an inva- 
lid, because of the severe jerking and the 
pains accompanying the contraction. There 
is now an almost constant involuntary ro- 
tation of the head to the left with a con- 
traction of the muscles of the neck. The 
more she tries to resist the contraction, the 
more severe they seem. The jerking is 
usually much worse at night when she re- 
tires, thus preventing sleep. A severe 
attack is brought on by a little worry or 
excitement, or usually occurs without any 
apparent cause, and comes on very sud- 
denly, and lasting from a few days to a 
week or more, during which time she is 
completely helpless because of the severe 
contraction and pains. 

On inspection of the patient, her head is 



drawn constantly to the left, and there is 
a clonic spasm or a convulsive tic in the 
muscles that rotates the head to the left 
The muscles are hypertrophied. The spasm 
and hypertrophy are both visible and pal- 
pable and painful to manipulation; pres- 
sure on the course of the spinal accessory 
nerve brings on an attack of violent con- 
tractions or spasms. The head is turned by 
the stemocleido-mastoid muscles, and the 
upper fibers of the trapezius whose princi- 
pal nerve supply is the spinal accessory. 
Examining the back of the neck with the 
head bent forward, you can see the con- 
traction of the muscles. The patient is able 
to move her head in any direction, but un- 
able to hold it there for any length of time, 
especially when suffering an attack. 

During the past year the shoulder of the 
left side has become involved so as to cause 
a raising of the shoulder during a spasm, 
and the tenderness and pain also extends 
down into the shoulder. The clinical his- 
tory of these cases are: As the disease 
progresses other muscles of the upper ex- 
tremity become involved, but I have never 
heard of a case where the muscles of the 
lower extremity became involved. 

The disease usually occurs in nervous, 
impatient, hypersensitive adults over twen- 
ty-five years of age, and usually in old age, 
as in this case, and it is said that most of 
the patients' heads turn to the left. 

The direct cause and pathology of this 
disease is not well understood; it is sup- 
posed to be due to an irritation of some 
kind acting on the peripheral motor neu- 
rone, or it is of central origin. An affection 
of the central motor neurone in the cortex 
of the brain. 

The treatment for these cases is very 
disappointing. To relieve the spasm we 
can and very often we are compelled to 
use the depressents, such as opium, mor 



54 



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THE MEDICAL SUMMARY 



55 



phine, chloral, cocaine, etc. Cocaine is said 
to relieve the spasm very effectively for a 
time, but as the disease is a progressive 
and chronic one, the drug habit soon be- 
comes worse than the disease itself, so I 
have never tried it. Some years ago some 
one recommended injections of atropine in- 
to the affected muscles, which later proved 
worthless. Conium has also been recom- 
mended and used with equal disappoint- 
ment. Cannabis indica has been recommend- 
ed and found to be useful for a time in con- 
trolling the spasm, but .never affects a cure. 
Electricity is also sometimes beneficial for 
a while, but in this case it has been very 
disappointing. I was advised to use arse- 
nauro for a long time with increasing doses, 
which I did with no improvement at all. 
The only way I can give the patient relief 
is by the use of morphine hypodermatically, 
or a combination opium and bromide; dur- 
ing a severe spell I keep the patient asleep 
or thoroughly under the toxic influence of 
morphine for several days, or until the 
spasm will subside, but such a treatment is 
only palative and very disgusting to both 
patient and physician, but at times the 
spasms are so severe and last so long that 
the patient must have relief in some way, 
and this is about the only way I can give it. 

The general health of the patient needs 
close attention, as the disease seems to in- 
crease as the general health declines. 

Dividing the sternocleido-mastoid muscle 
has been resorted to, but the ends would 
soon grow together, and the spasm would 
be as bad as ever. Division and a resection 
of an inch or two of the spinal accessory 
nerve was also resorted to, with some bene- 
fit, but as the disease would soon involve 
the other muscles, the spasms would be as 
bad as ever. 

Dr. Russell, of London, recommends di- 
viding the posterior branches of fourth and 
fifth upper cervical spinal nerves together 
with the spinal accessory, but such a treat- 
ment seems to be too serious in the aged 
patients for a disease that is not dangerous 
to life. 

Dr Hugh T. Patrick, of Chicago, says: 
"My own efforts to cure spasmodic torti- 
colis have been anything but satisfactory. 
Operative treatment has been notoriously 
unsatisfactory." E. E. Perisho, M.D. 

Strcator, 111. 



AN INTERROGATORY PAPER. 

Editor Medical Summary: 

A century ago eastern chimneys were 
constructed so they could be swept out by 
hoy, called chimney-sweeps, and so many 
of them suffered with caicinoma of the 
Fcictum, that it was knonn as chimi»ey- 
sweep's cancer. Now if the carcinomatous 
germ is found in the chimney soot, may it 
not be that in the present soot-filled atmos- 
phere which covers the fruit, as shown by 
the blackened hands of the p^'ckers, is one 
cause for the increase of carcinoma of the 
stomach, occular, catarrhal and other mu- 
cous diseases? Much fruit is eaten with- 
out washing or peeling. 

Fifty-five years ago, when a student, 
there were frequent epidemics of that hor- 
ror of horrors — hospital gangrene — and no 
wonder, for the surgical wards were filled 
with ''laudable pus" patients. The medical 
horror was child-bed and typhus fever. 
If their disappearance is not due to that 
best of all antiseptics, fresh pure air and 
cleanliness, what was it? Is it not this 
combination which enables the skillful sur- 
geon to successfully perform operations 
unthought of half a century ago? 

Dr. Joseph N. McDowell, of St. Louis, 
said: *There is no such thing as typhus 
fever — it is a more malignant form of ty- 
phoid. Typhoid, you're sick; typhus, you'ie 
sicker; typhud, by God, you're dead." 

Can a dose of aromatic sulphuric acid, 
given three times a day, cause the lime de- 
posit in the arteries of elderly people (ar- 
teriosclerosis), hardening of the nerves 
(sclerosis), affecting the nerves of the 
heart (the cause of heart failure), in the 
kidneys (giving rise to degeaerative 
changes), be removed by forming a calcium 
sulphate which is eliminated, and the cali- 
ber of the vessels in a measure restored, 
as we are told? 

Why is it when prominent men gtt sick 
and employ prominent doctors, they almost 
always die? Is it because such aiedical 
men are suffering with Osleritis and have 
lost confidence in medicine? O ye of little 
faith ! 

Why is appendicitis so common now, 
when forty years ago it was almost un- 
known. The answer to this question re- 
mains unanswered, as it is in the first stage 



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56 



THE MEDICAL SUMMARY 



of knowledge — the uncertainty of doubt. 
It seems to me that the change in fashion 
in dress may be an important factor. In 
former days the trousers were supported 
by suspenders; men now wear belts for 
that purpose, compressing the bowels suf- 
ficiently to make the weight rest on the 
hips and pelvis, and crowding the contents 
into every nook, crook and corner, the 
appendix among the rest. Women and 
some men bring about the same result with 
tight-fitting corsets, and women add skirts. 
To do away with tight-fitting corsets and 
male belts, I am convinced will largely les- 
sen the cases of appendicitis. 

Paraplegia is a common disease among 
hogs. A man had a lot of fat hogs, when 
12 of them "broke down" (dragging their 
hind legs on the ground). He was be- 
moaning his loss when a neighbor said, '1 
can cure them." At this the owner promis- 
ed him half he cured. In a short time they 
were well, and in answer to my question, 
how did he cure them, he replied, "I take 
the large blade of my knife and make a 
slit about four inches long down to the 
bone, then I fill it up with tar-pen-tine." 
How would this operation for the same dis- 
ease, minus or plus the "tar-pen-tine," act 
on the bimana? 

Chinamen never have diphtheria or 
other throat troubles. When in Tucson, 
Arizona, where large numbers of them re- 
side, the physicians told me this. The filthy 
water they drink out of the canals does not 
hurt them. Why is this? 

Amos Sawyer, M.D. 

Hillsboro, 111. 



ACUTE INDIGESTION AND SOME INTER- 
ESTING FACTS. 

Editor Medical Summary: 

Now and then we read in the daily press 
of the death of some prominent person 
from acute indigestion. Many sudden 
deaths in the night may be accounted for 
in this way. I have met with a good many 
cases of this condition and have always 
been able to relieve them in a short time. 
Patient complains of great distress in 
stomach, the pain is of a cramping nature. 
There is cold sweat on the forehead, cold 
hands and feet, all the blood seems settled 



m the trunk of the body, patient white as 
a sheet, pulse hardly perceptable. In this 
case whatever is done must be done quickly 
or the patient will die. There seems to be 
a partial stoppage of the circulation of the 
blood, suspension of all action of the stom- 
ach. Here a quick stimulant rs needed. 
Take a glass of water, add one teaspoon ful 
of aromatic spirits ammonia, one teaspoon- 
ful good French brandy; let the patient 
drink it all down at once. Repeat the dose 
in a few moments, if needed. In a very 
few moments the pulse will begin to beat 
stronger, fuller and more regular; patient 
will -begin to belch up gas, and the pain in 
stomach is relieved. 

We may have patients that are subject 
to such attacks, especially after eating a 
hearty meal. To prevent these attacks, to 
overcome the indigestion, I like nux vom- 
ica, second decimal trituration in tablet 
form, three tablets once in three hours. 

Tea drinking, fried eggs, cheese, fat 
greasy food should be cut out of the diet. 
Patients should eat slowly, chew the food 
over and over again to give the stomach 
as little work to do as possible. 

In a certain town in Pennsylvania where 
they use natural gas for heating purposes, 
there was an escapement of gas, the whole 
family was prostrated. A medical friend 
of mine was called to prescribe for them. 
Upon his return to his office he too suffered 
from the effects of the gas, vomiting, diar- 
rhea, and a bursting headache, pulse full, 
bounding, tense; indicating Veratrum vir. 
as the remedy he needed. 1 prescribed 
tincture veratrum vir., first decimal dilu- 
tion, 5 drops once an hour. After the doc- 
tor had taken one or two doses he was so 
much better that he went with me to the 
city hospital to see a case of typhoid fever. 
The next day he was perfectly well. 

No matter what the disease may be call- 
ed, when the pulse is full, bounding, tense, 
it means veratrum every time. Imagine if 
you will, a cord drawn tight from one point 
to another; place your finger on the cord, 
and you get the feeling of tension. When 
you feel that tension in the pulse it is an 
indication for tincture veratrum vir. I like 
the first decimal dilution as the best form 
to prescribe it in, for it gets the quickest 
results. The keynote for this remedy is 



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57 



congestion, whether it be in the lungs, 
brain or uterus. If the patient has pain 
anywhere in addition to the tension of the 
pulse you will get contraction of the pupils 
so that one confirms the other. When we 
know how to read the pulse in nine cases 
out of ten it will tell us the first remedy 
that our patient needs. 

En G. Jones, M.D. 
Burlington, N. J. 



ABUSED STOMACHS. 

Editor Medical Summary : 

I am old-fashioned in the practice of 
eating three meals a day, viz. : at 7 A. M., 
12 M. and 6 P. M. Now, I am a careful, 
moderate eater, but I am sure that we 
often eat the three meals when less would 
probably be better for our stomachs. Eat- 
ing is in a large measure a habit. We eat 
because the mealtime comes, whether we 
are hungry or not. Unless we are hungry, 
the stomach should have a rest. Then I 
eat plain, well-cooked meals, no rich viands, 
but good tgg or scalded cornmeal bread, 
or light rolls, moderately of meat, princi- 
pally beef roast, and boiled ham. Eat vege- 
tables and custards and pie. 

It is not so much what one eats as it is 
that he should not eat too much, nor too 
often. I have sat at table with such glut- 
onous caters that it seemed that they had 
bovine stomachs. The normal, average 
stomach should hold about a quart, but I 
know a sedentary banker who vomited 
about a gallon. If one knew how small the 
stomach really is, there would not be so 
much stuffing, and we would eat less, and 
give the stomach a chance. We have con- 
tracted and dilated stomachs. The con- 
tracted stomach cannot hold more than a 
small amount of digestible diet, preferably 
liquids, and cream. The dilated stomach 
will hold much more, but will not readily 
dispose of its contents; on the contrary, 
the food will ferment, and distress from 
gas will be miserable. 

It is a pity that one of the most impor- 
tant organs is constantly outraged. It is a 
^^onde^ that sots and gluttons live as long 
as they do. Sots will eat stuff that a dog 
would reject. They will eat stale and con- 
. glomerate saloon counter lunches that a 



cast-iron stomach would not digest. Then 
think of the bug-juice they guzzle! They 
are akin to swill-fed swine that feast on 
distillery slops. 

Some men eat such heavy suppers that 
they roll and toss all night, and have fright- 
ful dreams. Big meat eaters can not sleep 
sound. Then big eaters who do no manual 
labor, lay the foundation for Bright's dis- 
ease, liver disease, diabetes and gastritis. 

One among the commonest abuses of the 
stomach consists in gulping down large 
draughts of ice water, or iced tea, with the 
meals. As a matter of course, the stomach 
is chilled, the process of digestion is re- 
tarded, and soon '*stomach trouble" super- 
venes. Any one who knows anything about 
digestion must know that the food must be 
heated to a certain temperature by the 
stomach before digestion begins, and large 
draughts of cold water dilutes the gastric 
juice to such an extent that serious conse- 
quences will sooner or later follow. I have 
known working men who ate cold "grub" 
from their lunch baskets who soon devel- 
oped indigestion and gastralgia, and so soon 
as I got them to eat warm meals their stom- 
ach pains disappeared. Then the food it- 
self was generally the product of bad cook- 
ery. Very few housewives know how to 
cook digestable aliment. The man who 
carries in his lunch box cold potatoes, sog- 
gy biscuits, cold meat, cold hard-boiled 
^gg^y pie and cake, cannot escape stomach 
trouble. Such stuff is bound to lie in the 
stomach, to undergo fermentation and pu- 
trefaction. The effect of this condition is 
flatulence of both stomach and bowels. 
The continued abuse of the stomach finally 
results in dyspepsia, with depression of 
spirits, distress after eating, coldness of the 
extremeties, flushing of the face, headaches, 
palpitation, erythema, dyspnoea, cough, 
hoarseness, catarrh, foul breath, nervous- 
ness, insomnia, nausea, gastralgia, and a 
feeling of fullness and distension, with a 
weight in the stomach. 

All these dire symptoms from abuse of 
the organ are very apt, in time, to produce 
grave organic disease. No doubt, nine 
cases out of ten of organic disease come 
from the persistent abuse of the stomach. 
When will people learn to eat right, eat at 
proper times, and eat digestible food to 



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THE MEDICAL SUMMARY 



moderation? Among the healthiest per- 
sons are the small eaters, who eat at sea- 
sonable hours, and don't indulge in *'Dutch 
suppers" and midnight lunches. 

D. L. Field, M.D. 
Jeffersonville, Ind. 



CAPSICUM. 



Editor Medical Summary: 

The common household remedy to **break 
*ip a cold," to warm up a person having a 
chill, or to relieve cramps in the stomach 
or intestines, is alcohol in some form, usu- 
ally whiskey, brandy or gin. It is not the 
wisest or safest method to advocate to our 
patients the frequent and common use of 
alcohol, especially when we have at our 
command a remedy equal to and often su- 
perior to the action of alcohol. The rem- 
edy I am about to describe is capsicum, the 
common cayenne or red pepper. Capsicum 
is a pure stimulant, but in large doses it 
produces vomiting, purging, dizziness and 
inflammation of the stomach and bowels. 
It is a safe and harmless remedy if prop- 
erly used. It has long been used in laxa- 
tive pills, thereby improving the capillary 
circulation and nerve tone of the entire 
intestinal tract. It is an excellent sedative 
in delirium tremens, producing a quiet and 
in some a deep sleep. It should be given in 
conjunction with concentrated nutrition. 

This remedy can safely stand in any 
medicine closet or elsewhere, and it will 
never make any person a drunkard. It is 
excellent in the atonic dyspepsia of the al- 
coholic habitues, and in large doses will 
relieve the craving for alcoholic drink; be- 
sides it is the very best remedy we possess 
for delirium tremens. It is also serviceable 
in the treatment of opium and cocaine 
habits. It may be combined with strych- 
nine, hydrastine or other nerve stimulants 
and tonics. In relaxed conditions of the 
pharynx and post-nasal membranes, it has 
a most beneficial influence. 

It has no equal to warm up a person suf- 
fering from a cold or chill. A hot infusion 
is the most active. A serviceable gargle is 
made by placing in a cup of hot water a 
teaspoonful each of capsicum and salt: af- 
ter standing a few minutes pour off the 
top and add a cup of vinegar. 



Used externally capsicum is of great val- 
ue, producing an active rubefacient effect 
without vesication. In the treatment of 
chilblaines it will excell where other and 
better remedies have failed. 

Oleoresin of capsicum spread on common 
adhesive plaster makes an excellent pain 
plaster, which you can assure your patient 
will not blister, and may be left in place 
four or five days. 

Teach the laity the use of capsicum, and 
it will soon replace the alcoholic prepara- 
tions. Capsicum will not produce a drug 
habit, but is absolutely safe in the hands 
of all. E. N. RiTTER, M.D. 

Williamsport, Pa. 



INSTRUMENTAL DELIVERY. 



Editor Medical Summary : 

I was very much interested in an edi- 
torial in the November number of The 
Summary, entitled "Instrumental Deliv- 
ery." You stated, "Forceps are the most 
valuable invention the world has ever 
known." In the same editorial you con- 
demned the reckless and injudicious em- 
ployment of forceps. I heartily concur in 
both propositions. The subject presents a 
field for scientific thought and is well 
worthy the serious consideration of the pro- 
fession. A year or two ago I read a 
paper from Dr. — , in which bias was ex- 
tremely marked. He condemned the for- 
ceps in strong language and said that he 
had never owned such instruments. He 
boasted that he had attended over 300 cases 
of confinement without once finding it nec- 
essary to resort to the instruments; said 
he had never lost a woman either in child- 
birth or after, and this, "I believe my suc- 
cess is largely due to my preparatory treat- 
ment of the pregnant woman." Such state- 
ments are as puzzling to me as a Chinese 
riddle book. This preparatory treatment or 
labor being rendered painless by any pro- 
cess except under anesthetics savors strong- 
ly of quackery. 

I am reminded of a conversation I had 
many years since with an old doctor who 
has long since been "gathered to his fath- 
ers," and presumably many of his patients 
have ere this answered the summons of the 
pale courier. This man had then practiced 



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59 



a long time — as he put it, **had been forty 
years in the saddle." He evidently thought 
his advice would be helpful to me, which 
he gave without stint. Among other things 
he said: ''Doctor, prescribe for your ob- 
stetric patients black cohosh; it is a great 
medicine to relax the bones of the pelvis." 
At that time I had a good woman and some 
babies to care for in this wicked world, 
and was therefore restrained from commit- 
ting a tragedy. 

Regarding the forceps, I am satisfied that 
the bad reputation they have among the 
laity has been transmitted from an age 
more or less remote. In the old days it 
was the custom of many physicians to pre- 
scribe ergot to their parturient patients, 
and only after that drug had failed to re- 
sort to instrumental delivery, as an extreme 
measure, and that without regard to asep- 
sis. With a full recognition of the baneful 
results attending the injudicious employ- 
ment of the forceps and summing up my 
experience and observation covering a per- 
iod of about forty years, leaves me with the 
impression that the forceps have been in 
a great measure conducive to the comfort 
and healthful advantages of the parturient 
woman, and therefore remains a permanent 
contribution to our means of alleviating 
the agony incident to child-birth. 

I will close by citing a case. Mrs. L. C. 
was taken in confinement in August. Dr. 
H., who held authority by virtue of some 
clause in our State laws, attended her. He 
sat by the woman's bedside hour after hour 
doing nothing except to frequently promise 
success, until some fifty hours had passed. 
It was an aggravated instance of incompe- 
tency, rendered more vexatious by the 
man's stupid indifference to the peril of his 
patient. Dr. E. S. Porter, of Milan, was 
finally called and delivered the woman 
quickly and easily with forceps. The child 
was still-bom. The long pressure low down 
in the pelvis had done its fearful work. 
The woman succumbed in about a week. 
Toward the end the soft parts sloughed, 
and even the bladder became involved. It 
is quite evident that in this instance two 
lives could have been saved by the timely 
use of the instruments. 

Chas. VanWye, M.D. 

Browning, Mo. 



EARLY MENOPAUSE. 

Editor Medical Summary : 

Several weeks ago a lady called at my 
office and wanted medicine to quiet her 
nerves, she being under a physical strain 
on account of having just gone through the 
divorce court. I asked her some questions 
before prescribing as to her general health, 
among others as to her menstrual flow. She 
said: **Dr. Surface, I have not seen any- 
thing since I was twenty-two." I asked 
her at what age she began menstruating, 
and she replied at eleven years, and con- 
tinued regularly until twenty-two, when it 
ceased without any untoward symptoms. 
She married at twenty-seven, and as one 
would naturally suppose, never became 
pregnant. She lived with her husband sev- 
en years. She is a large, strong woman, 
with a remarkably developed bust, and, I 
judge, will weigh 185 pounds, and is en- 
joying excellent health. I have never had 
an opportunity to examine her uterus, but 
will do so if I have an opportunity. 

She has a sister whom I have treated 
who has had three children and two mis- 
carriages, who is twenty-seven. 

I believe Dr. Tilt records a case where 
the menses ceased at twenty-one. Outside 
of this mine is the youngest I have ever 
read of that I remember. 

O. B. Surface, M.D. 

1618 Shelby St., Indianapolis, Ind. 



ODDS Am) ENDS. 



Editor Medical Summary: 

As to advertising matter in the indepen- 
dent medical journals, I do not see how 
much objection can be raised when the 
advertising matter is kept on the advertis- 
ing pages, where it belongs, and the editors 
use reasonable care in excluding palpable 
frauds and matter which is evidently go- 
ing to be published to the laity in the fu- 
ture. We live in an advertising age, and 
most magazines earn a legitimate part of 
their income from their advertising pages. 
An official journal with a dead-sure sub- 
scription list, can afford to arbitrarily 
knock any advertisement in any indepen- 
dent magazine whenever the fit is on. 



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THE MEDICAL SUMMARY 



An immense amount of advertising is 
done to the medical profession. The post- 
age on letters and circulars sent to me 
from advertising houses amounts to about 
$35 per annum. Not all of it goes into the 
waste-basket unopened. I believe that the 
apparatus cricitus of the average doctor is 
able to protect him and his patients from 
the wiles of fraudulent or over-optimistic 
advertisements. 

Most of my patients are really sick when 
they call for a physician, and the practice 
of medicine here is generally a serious 
business, nevertheless amusing things oc- 
cur parallel with all the serious and even 
the tragic events in human life. 

A girl of thirteen years when viewing 
her newly-acquired baby brother, was not 
altogether satisfied with his appearance. 
Turning to her mother she said, **Mamn.a, 
do you know, I think Dr. Miller brought 
us a stale baby !" 

A blacksmith patient of mine who was 
having a set of chills originally secured 
from the State of Arkansas, was given 
some compound cathartic pills one evening, 
and they took no uncertain effect during 
my call the next morning. "You must ex- 
cuse me, doctor," said the patient, "I tried 
to put it off until you were gone." 

Y'ou have all probably heard of the Irish- 
man who wanted his son to be a doctor, 
because he thought it was such "a nice 
clean job." I guess Pat would change his 
opinion if he could go with us on our daily 
rounds. The idea which many have of 
practice may be briefly summed up as fol- 
lows : "Let's see your tongue. Count your 
pulse. Get your temperature. Get this 
prescription filled. Two dollars, please. 
See you to-morrow. Good-bye." 

A young mother who was in ill health 
secured some germicidal suppositories with 
a view to limiting the population in her 
immediate vicinity. She took them per os 
facialis. The ultimate result was an in- 
crease in the latest census. 

The English language is full of snares 
and pitfalls for the foreigner who tries to 
master it. One of my little patients had 
"ammonia on the lungs," according to his 
parents, and was given an "injunction" be- 
fore my arrival. Most of my colored pa- 
tients have just one disease, and that is 



**de misery." This is given with a local 
appellation varying as to the seat of the 
misery. By the way, it is more difficult to 
diagnose and treat disease in the colored 
than in the white race. They are wonder- 
fully kind to each other in sickness, and 
they generally pay me for my services. 
Disease is no respecter of persons, and it 
is our duty to fight him wherever he ap- 
pears. 

Each ward of the Cook County Hospital 
has a small ward containing four beds in 
which are placed the most seriously ill or 
those who seem about to die. A certain 
large ward was full and there was only 
one bed vacant, which was one in the small 
ward. A Mr. Quin, who had only a slight 
injury, was admitted to the ward and had 
to be placed in the vacant bed in the "death 
ward." During the night the patients in 
the beds on each side of him closed their 
earthly, careers. In the morning a bed was 
vacant in the large ward, and the nurse 
came to remove Quin thereto. The nurse 
was explaining to him the cause of the 
change, when he said, "What's the use of 
changing me ? This is a nice, quiet place !" 
E. P. S. Miller, M.D. 

2001 West Lake St., Chicago, 111. 



VESICULAR MOLE. 



Editor Medical Summary: 

In reading through the December num- 
ber of the Summary, Dr. Carpenter's his- 
tory of "A Patient in Great Danger" 
brought to my mind my own experience 
last July with a case of vesicular mole. The 
patient was a woman aged 32, mother of 
two children, and supposed by herself to 
be in the fifth month of pregnancy. Dur- 
ing the month previous to coming to the 
hospital she had had two or three uterine 
hemorrhages, the last one being the most 
severe. The writer made a diagnosis of 
partial or complete placenta praevia, and 
the patient was closely watched. Twenty- 
four hours later the woman experienced se- 
vere pain, followed by dangerous hemor- 
rhage. I was hurriedly called at 2 A. M. 
and found my patient in shock and almost 
exsanguinated. She was hurriedly prepar- 
ed for the operating table, and preparations 
made for emptying the uterus, strychnine 



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phos. gr. 1/30, having previously been ad- 
ministered hypodennically. The speculum 
was introduced and the cervix pulled down 
with a tenaculiun. Immediately another 
profuse hemorrhage followed, and without 
a moment's delay I introduced a dull curette 
and rapidly emptied the uterus, the inside 
of which contained several quarts of vesi- 
cular mole mixed with blood clots. The 
former had the exact appearance of boiled 
sago. The curettage did not occupy but a 
few moments* time, which was followed by 
a hot saline intra uterine douche. Hem- 
orrhage ceased at once and there was no 
return of it Fid. extract ergot, 3ss, was 
administered, and warm saline solutions, 8 
ounces, repeated in an hour, injected into 
the abdominal tissues. The patient was re- 
moved to the ward, put on a hot floor and 
covered with warm blankets, with hot 
bricks to her feet and sides. 

In ten days the woman was walking 
around, and a few days later returned to 
her home, saying she felt as well as ever. 
E. Douglas Follwell, M.D. 

Pyeng Yang, Korea. 



TYPHOID FEVER.— REPLY. 

Editor Medical Summary: 

I have read the article by Dr. Oldham, of 
Mt. Juliet, Tenn., in February number of 
the Summary, page 369. He intimates that 
he does not believe a case of typhoid fever 
can be cured, or aborted, or rather that 
he cannot do it. Upon a careful review of 
the case he has reported and the methods 
employed, it . looks plausable indeed, that 
the ailment cannot be aborted. 

In placing a patient on cold storage for 
one hour at a time, then subjecting him to 
the scalding process for the same length of 
time, in the meantime administering 8 grs. 
of calomel and 4 grs. quinine every two 
hours, will not abort a case of typhoid; it 
cannot be done ; but I attribute the doctor's 
failure in this case to the exceedingly 
strong constitution of his patient. Ordi- 
narily this would have done the work, and 
the doctor could have given the family his 
word that the trouble would never return. 

Now that the doctor has tried to abort a 
case of typhoid and failed, I have a curios- 
ity in wanting to know if he has ever tried 



to cure a case, and if so, what methods he 
used ? 

In conclusion, I want to say with empha- 
sis, that if I did not have confidence in 
medicines, or in my ability to administer 
them properly in any disease, amenable to 
treatment as is typhoid fever, I would take 
down my "shingle," and would not dis- 
credit the medical profession by saying in 
substance, that medicine is a humbug. 
G. W. Isaacs, M.D. 

Woodstock, Ky. 

[From the above we take for granted that 
Dr. Isaacs has had a large measure of suc- 
cess in the treatment of his typhoid fever 
cases, and we trust that he will see fit to 
let the Summary readers have an outline of 
his manner of treating those cases in some 
future issue of the Summary. — Ed.] 



DIAGNOSTIC POINTS. 

The following paragraphs are excerpts 
from an article by Dr. Geo. F. Butler, in 
American Journal of Clinical Medicine: 

A dull pain at the back of the head, with 
lassitude and despondency, is generally an 
evidence of an excess of phosphates in the 
urine. 

Drooping eyelids that cannot be voluntar- 
ily raised, unless following injury or dis- 
ease causing paralysis of the third nerve, 
are apt to indicate apoplectic plegia. 

A small, movable pea-like body in the 
lobe of the ear, a deposit of urate of soda, 
suggests a gouty or rheumatic diathesis. 

When the feet alone are swollen the 
heart is usually involved; when the abdo- 
men only is swollen, the lives is usually at 
fault. 

A persistent bad taste on rising in the 
morning, independent of stomach derange- 
ment, is apt to point to threatening cardiac 
trouble. 

Club-shaped ends of the fingers suggest 
phthisis, empyema or heart disease. 

When a perfectly sound leg drags after 
its fellow and there is inability to raise it 
from the ground, it is apt to be impending 
evidence of disease of the spine. 

Superficial varicose veins on the abdo- 
men are evidence of deep venous obstruc- 
tion and may indicate cirrhosis of the liver. 



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Blair's Pocket Therapeutics: A Practi- 
tioner's Hand-book of Medical Treat- 
ment. By Thomas S. Blair, M.D., Neu- 
rologist to Harrisburg (Pa.) Hospital. 
Author of "A System of Public Hy- 
giene," "Blair's Practitioner's Handbook 
of Materia Medica," Member of the Har- 
risburg Academy of Medicine, American 
Medical Association, etc. The Medical 
Council Co., Publishers, 42nd & Chestnut 
Sts., Philadelphia, Pa. 191 1. Price, $2. 
This book is published on quite thin pa- 
per, almost 375 pages, bound in limp leath- 
er, pocket size. It represents a condensed 
discussion of what the author believes to 
be the best methods of treatment, and along 
with this is given an occasional well-tried 
formula. 

The diseases treated are divided into re- 
lated groups, each group occupying a chap- 
ter; a copious alphabetical index provides 
for instant reference to any particular dis- 
ease. 

The closing chapter gives Treatment of 
Poisoning (arranged alphabetically as to 
the different poisons). The Appendix gives 
many necessary tables for quick reference, 
followed by an exhaustive Table of Doses, 
closing with a General Index. 

This is an excellent book for instant ref- 
erence. 

The Taylor Pocket Case Record. — By J. 
J. Taylor, M.D., 252 pages, tough bond 
paper; red limp leather. The Medical 
Council Co., Publishers, 42nd & Chestnut 
Sts., Philadelphia, Pa. 191 1. Price, $1. 
A carefully-kept case record makes for 
discipline and accuracy in diagnosis and 
treatment as well. Without such a record 
the physician is compelled to depend en- 
tirely too much on his memory, and let that 
be ever so good, no one can possibly re- 
member all the important points of interest, 
even in say a half-dozen of the most im- 
portant cases; how much less in all the 
important cases he treats throughout the 
year. 



The young physician, the beginner espec- 
ially, should get into the habit of keeping a 
case record, as at that time he generally 
has plenty of leisure to give it careful at- 
tention, while the busy practitioner may 
not have sufficient time to jot down all the 
details of his most important cases. 

However, the book before us is so con- 
densed in form that the necessary data can 
be written down in the briefest possible 
time, and its being of pocket size, the phy- 
sician can always have it with him. A syl- 
labus, detailing all the points that should 
be considered in each case is given. 

Fourth Report of the Wellcome Tropi- 
cal Research Laboratories, at the Gor- 
don Memorial College, Khartoum. Vol- 
ume B. — General Science, Andrew Bal- 
four, M.D., Director. Published for De- 
partment of Education, Sudan Govern- 
ment, Khartoum. By Bailliere, Tindall 
& Cox, London. Toga Publishing Co., 
35 W. 33rd St., New York City. Depot 
for United States. 191 1. Price, $4.50. 

This book contains 334 pages, including 
22 pages of index; 9 colored plates, 52 re- 
productions of black-and-white drawings; 
98 reproductions of photographs and wash 
drawings; and 30 maps and plans. In the 
February Summary we gave a notice of 
Volume A, (Medical) : now we have be- 
fore us Volume B, (General Science), 
which is no less valuable in its way; in 
fact, it is an important work, handsomely 
printed and profusely illustrated. The fol- 
lowing are a few of the great number of 
subjects treated: A Test for Hashish, Me- 
chanical Analysis of Arid Soils, Gypsum as 
a Fertilizer for Sudan Soils, Experiments 
on Gum Production in Kordofan, Insects 
Injurious to Man and Animals, Animals In- 
jurious to Farm and Garden Crops, The 
Finches and Weaver Birds of the Sudan, 
Two Specimens of Spitting- Snakes from 
Southern Rhodesia, Ancient Gold Mining 
in the Sudan, Some Tribal Customs in 



62 



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63 



Their Relation to the Medicine and Morals 
of the Nyam-Nyam and Gour Peoples in- 
habiting the Bahr-£1-Ghaza. 

The Physiology of Faith and Fear; or, 
The Mind in Health and Disease. By 
William S, Sadler, M.D., Prof. Physiol- 
ogic Therapeutics, Post-Graduate Medi- 
cal School of Chicago. Author of "The 
Science of Living, or, The Art of Keep- 
ing Well," "The Cause and Cure of 
Colds," etc. Illustrated. A. C. McClurg 
& Co., Publishers, Chicago, 111. 1912. 
Price, $1.50. 

This is a very interesting book for any- 
one to read, in or out of the profession. 
It is the third of a series of medical books 
for the laity by this author, who writes like 
one with thorough command of the English 
language. There is nothing technical about 
it, but so simple and plain that any one can 
understand all presented discussions of the 
fundamental laws and underlying princi- 
ples of mental healing in an unbiased man- 
ner. The psychology, physiology and ther- 
apeutics of the mental states are fully pre- 
sented, including the latest methods of 
physhotheropy. 

Although our space is limited, we can- 
not refrain from giving as an illustration 
how the mind is able to influence asthma 
and hay-fever : "The influence of the mind 
over the breathing under such circum- 
stances is further shown by the experience 
of the asthmatic patient who awakened in 
his hotel room in the middle of the night, 
attacked with a fit of suffocation. He made 
an urgent appeal to the nurse to open wide 
the windows. The nurse in the excitement 
and in the darkness, was unable to open the 
window, whereupon the patient exclaimed, 
'Break the glass! break it!' Immediately 
the nurse seized a chair and sent it crash- 
ing through the supposed window, and in- 
stantly the patient began to breathe more 
easily, and subsequently remarked that he 
thought he would have smothered to death 
had not the nurse not promptly broken the 
window. All went well until by the light 
of the early dawn it was discovered that 
the windows were all securely and tightly 
fastened down ; the nurse had only broken 
the glass door of a large book-case." 



LITESAST NOTES. 



^^«- 



We have before us a reprint of an article, 
"Elevation of Temperature — An Early and 
Often Enduring Symptom of Hyperthyroid- 
ism," written by Dr. Heinrich Stern of New 
York, the article first having been pub- 
lished in "The Archives of Diagnosis." The 
subject is handled in a masterly manner and 
the writer at the outset points out the fact 
that the toxic state known as hyperthyriodism 
may exist in the absence of thyroid enlarge- 
ment, exopthalmos, tremor, and persistent 
tachycardia. The writer emphasizes the fact 
that early and rather persistent elevation of 
temperature of a degree or two is one of the 
most certain diagnostic signs. Many cases 
that pass as neurasthenia, hysteria, etc., 
without a palpable etiological basis, he thinks 
are often manifestations of hyperthroidism. 

It would not be amiss for those intending 
to go to Hot Springs, Ark., or even phy- 
sicians, to familiarize themselves with the 
two pamphlets recetly issued by the Govern- 
ment Printing Office, Washington, D.C. One 
of these gives general information regarding 
the Hot Springs of Arkansas; the other is a 
report of the Medical Director of the Hot 
Spring Reservation to the Secretary of the 
Interior. 

The Medical Director, Harry M. Hallock, 
Major and Surgeon of U.S.A., retired, says 
that there is every reason for believing that 
Hot Springs has entered upon an era of 
legitimate development as a national health 
resort, and that the spirit of commercialism 
which has so largely dominated local condi- 
tions in the past is rapidly giving way before 
the progressive and reform element that has 
been awakened in the local community. 

If you are in a rut get out of it — and the 
only way to do this is to keep your eyes 
open on developments taking place all along 
the line, as it were. One of the ablest lead- 
ers in non-drug treatment of diseases is Dr. 
Albert Abrams, late of the medical faculty of 
Sanford University, Cal. He has been in- 
vited by the British Medical Association to 
participate at the next annual meeting in 
July, and on his way east will give his course 
on Spondylotherapy in Indianapolis, Cincin- 
nati, Cleveland, Pittsburgh, and Philadelphia. 
Arrangements are being made by Mr. I. W. 
Long, loi High Street, Columbus, Ohio. 
Those interested should write Mr. Long. 
See announcement on another page of this 
issue. 



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In tubercular hemorrhage, Hydrastis is 
an excellent pulmonary hemostatic. 

In iodoform poisoning give an emetic fol- 
lowed by 20 grains of potassium bromide. 

Pilocarpine is very useful in poisoning 
by alcohol and belladonna. 

Phenolphthalein is the ideal infant laxa- 
tive when constipation is the only symptom. 

In nocturnal inco^itinence or in night ter- 
rors look for adenoids in the naso-pharynx. 

Snuffles and pui'ulent rhinitis in young 
children may be due to syphilitic parents. 

A crying infant probably has the stomach 
ache, earache, or is hungry; try an enema. 

More trouble comes from over-feeding 
than from under- feeding infants. 

Bromide of soda in 20-grain doses is ex- 
cellent in relieving the itching of urticaria. 

A calomel purge followed by an ice bag 
to the appendix will often abort an attack 
of appendicitis, if used early. 

In every case of running ears or earache 
look for adenoids in the naso-pharynx and 
remove them. 

Absolute rest and diet will do more for 
gastric ulcer than any other form of treat- 
ment; medicine is of no avail without it. 

So-called liver spots can be cured by the 
application of an ointment of salicylic 
acid, 10%. 

For bums of the first degree a saturated 
solution of picric acid (75 grs. to oz.) free- 
ly applied gives instant relief. 

Ichthyol is of some service in pulmonary 
tuberculosis if given in capsule form in 
doses gradually increasing up to 30 grains. 

A good febrifuge is composed of ace- 
tan ilid, nitrate of potassium, bicarbonate 



of soda and minute doses of powdered 
ipecac. 

In hemorrhage from lungs, kidneys, in- 
testines or stomach, atropine is the best 
remedy; from uterus, Hydrastis or ergot; 
from the lower bowel, hamamelis. 

In any internal hemorrhage nitroglycer- 
in will aid other remedies by dilating the 
superficial capillaries, thus lessening the in- 
ternal pressure. 

Don't forget that so-called "female trou- 
ble" may come from the bladder wholly, 
and will be relieved by local treatment to 
the bladder and mucosa only. 

If you have made any discoveries, doc- 
tor, please report them to The Summary. 
Don't use over 1000 words; 100 would per- 
haps be better. 

In the treatment of bums, carbolized 
sweet oil in the proportion of one dram of 
carbolic acid to each six ounces of oil is 
said to make an excellent dressing. 

Carbuncles may be aborted in their early 
stage by an injection of two to three min- 
ims of an 80% solution of carbolic acid in 
glycerin. Later 15 to 30 minims are needed. 

Equal parts of carbolic acid and tincture 
of green soap make a good disinfectant 
wash for the hands and can be used full 
strength without injury. 

Creosote should not be given to patients 
with fever or signs of congestion, nor with 
loss of appetite or long continued hectic. 
It may be given where there is no fever or 
only the slight fever of suppuration. 

Iris versicolor influences every gland in 
the body, and for that reason it g^ves very 
good results in treatment of goiter. For 
chronic or malarial jaundice, iris will be 
found one of the most valuable and sure 
acting remedies. In my practice I find it a 
very great aid to the work of elimination 
done by liver and kidneys. — Dr. Gregory. 



64 



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A MoQthly JounuJ of 

Practical Medicine, New Preparations; Etc. 

R. H. ANDREWS, M.Dm Editor and Publiiher* 2321 Patk Ave.. PhOa.. Pa. 
One Dollar Per Anninn in Advance. Sintf e Copies. 10 Cents 



VoL XXXIV. 



Phaaddphia. May. 1912. 



Na 3 



fUBSOSIPTION BATES: fl.OO per ysar, in ad- 
▼ano0, to amr part of the United States and 
Meiieo. To Foreicn Countries and Canada, $1.86. 

SSW SXTBSCBIPTIONS may begin at any time dur- 
ing the year. 

BOW TO BEMIT: A safe way to remit is by postal 
money order, express order, check, draft, or regis- 
tsred mall. Currency sent by ordinary mail nsn- 
aQy reaches ^ts destination safely, bnt money so 
ssnt mnst be at the risk of the sender. 

BBCBZPT8: The receipt of all money is immedi* 
ately acknowledged by a postal card. 

0HAHOB8 OF ADDBESS: Subscribers changing their 
addresses should immediately notify us of their 
present and past locations. We eannot hold our- 
sehres responsible for non-receipt of the Journal 
hi suck cases, unless we are thus notified. 

DISCOHTZNTTAirCBS: The Summary is continued to 
lesponsible subscribers until the publisher is noti- 
fied by mail to discontinue, when payment of all 
arrearages mnst be made. If yon do not wish 
The Summary continued for another year after 
the time paiil for has expired, please notify us to 
that eireet. Address 

'THE MEDICAL 8XJMMABT," 



tSfil Park Ave., 



Philadelphia, Pa. 



Satered at Phila. Post Ofllce as second-class matter. 

ALCOHOL INJECTIONS FOR NEURALGIA. 

Alcohol injections at the site of. exit of 
the second and third branches of the tri- 
facial nerve from the skull give excellent 
results. As it is perfectly possible to re- 
peat these injections in case of a recur- 
rence, this form of treatment is distinctly 
preferable to operation. It is impossible to 
treat the first branch of the nerve in this 
manner, but a more peripheral application 
might be worked out which would be ef- 
fective. 



MAY MUSINGS. 

May and June are the healthiest months 
throughout most sections of the United 
States. It is during these balmy, invigor- 
ating months that the mortuary list runs 
lowest, the acute diseases abate, and the 
semi-invalids seem to get for the time-being 
a new lease on life. With a paucity of 
work and longer days in which to do it, 
many doctors find time hanging heavily on 
their hands about this time of the year. Will 
any of our readers heed a bit of paternal- 
istic counsel? In thus dealing out advice 
do not imagine, doctor, that we are pre- 
suming upon your intelligence and your 
manhood. Far be it from us so to do. We 
fully realize that the words of the self- 
appointed monitor are usually sown on 
stony ground. These suggestions are there- 
fore more in the way of reminders than of 
advice per se. 

While you have an abundance of time, 
post up your books and send out statements 
rather voluminously. Occasional full set- 
tlements and understandings should be 
made with the good patrons as well as the 
poor ones. Otherwise they are not "good." 

Overhaul and rehabilitate that decrepit 
electrical outfit. It probably got out of 
commission during the winter when you 
were ver}' busy, and you remarked to your- 
self then that you would fix it up when you 
had more time. It may be that your nebu- 
lizer, your medical and surgical outfits, your 
medicine shelves and a few other pieces of 



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THE MEDICAL SUMMARY 



your armamentarium need a bit of going 
over. 

Has your equipment left off its winter 
earmarks and taken on summer dress? 
Have you made the necessary seasonable 
changes? 

Every doctor who wants to be progres- 
sive should map out a line of study and 
research now while he has time and oppor- 
tunity. It is never too late to begin. The 
majority of successful physicians are stud- 
ious men, although not necessarily book- 
worms. Be studious and industrious and 
you will be a better physician five or ten 
years hence. And you will be better satis- 
. fied with yourself. 

Read collateral sciences and become a 
thoroughly rounded-out man as well a^ a 
capable physician. The time has come when 
the doctor must be a man among men. 
The magazines and newspapers are now 
presenting medical subjects to the lay world 
and the searchlight of knowledge — all kinds 
of knowledge — is boring into every be- 
nighted comer. The phjrsician must be a 
man of culture and versatility or the laity 
will soon find him out. 

Versatility does not consist alone in ac- 
quainting oneself with ponderous subjects. 
We need rest and diversion as well as 
work and application. If a physician ex- 
pects to attain a happy and healthy ad- 
vanced age his work and play must be judi- 
ciously balanced and faithfully carried out. 
Doctor, if there ever was a time when 
you ought to be happy and really glad that 
you are alive, that time is here and now. 



INHALATIONS FOR BRONCHITIS. 

Put a few drops of nitric acid in boiling 
water and inhale the fumes for five or ten 
minutes. Bronchial irritation is lessened 
with a corresponding salutary effect upon 
the mucous membranes. One observer ad- 
vises the placing about the room of the 
sufferer from chronic bronchitis five or six 
pieces of filter paper which have been 
soaked in the following: 

Menthol, 

Eucalyptol aa 3ij. 

Oil turpentine, 

Spirits juniper aa 5v. 



OPTIMISM A GOOD ASSrr. 



A contented^ optimistic attitude of mind 
is one of the best things the doctor can 
possess. It may be foolish to be happy and 
it may not be uproariously progressive to 
be of serene, tranquil temperament. But it 
pays in the end. It pays to be cheerful and 
hopeful and loving for its good reactionary 
effect upon ourselves if for no other reason. 

It is a laudable ambition, to be sure, to 
endeavor to increase your practice; but if 
such increase can not be obtained by fair 
and honorable means, then the best thing is 
to be satisfied with conditions as they arc 
The doctor with a monumental business 
has little time for self -improvement or for 
doing the little things that he really likes 
to do. Remember that while woric is a 
good thing for all of us, too much of it 
sooner or later tells on us, and we find 
ourselves growing prematurely old It 
takes both money and energy to carry on 
a big business of any kind, the practice of 
medicine being no exception. 

If you have considerable time that is 
really your own, you are afforded a better 
opportunity to look after your little invest- 
ments, your property, and your family. 
Again, you are the better permitted lo con- 
serve your own health. All these things 
are in the end of much more vital concern 
than the serving of a wide and diversified 
clientele who will soon forget you anyway. 

Yes, be cheerful and optimistic. So many 
doctors say to themselves: "I will begin 
next week or next year to slow down and 
get to enjoying life." Unfortunately that 
time for many never comes. The lives of 
so many doctors we know are filled with 
turmoil and wavering doubts and fears for 
the future. Cast off that mental unrest to- 
day, doctor, and begin leading a hopeful, 
contented life. As a seasonable poetic sug- 
gestion, let us remember that "it is not 
always May." 



Creosote is one of our best therapeutic 
agencies in lung and bronchial affections. 
It is better administered well-diluted in a 
suitable vehicle rather than in pill or cap- 
sule form. 



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DO YOU READ THE ADVERTISEMBHTS? 



BABIES IN STYLE. 



Do not skip the advertising pages, doc- 
tor. Some of the best things at the com- 
mand of the profession appear first as ad- 
vertisements. Some of our most depend- 
able agencies rank as proprietaries. In The 
Summary pages may be found announce- 
ments of goods of a varied sort that are a 
s\n€ qua non to the profession. Advertisers 
are with few exceptions honest and pre- 
sent their goods with faith in them and 
with faith in physicians. If it were not for 
medical advertisements there would not be 
a dozen medical journals in existence. So 
we urge the reading of what advertisers 
have to say to you. If anything especially 
appeals to you write the firm for more in- 
formation. This you will invariably re- 
ceive promptly, and if it be possible sam- 
ples will also be sent you. Don't be a 
"sample fiend," but nevertheless ask for 
anything that really appeals to you. When 
writing to advertisers you will confer a 
favor on us by stating that you saw the an- 
nouncement in The Medical Summary. 



POISON IVY. 



This is the season of the type of dermati- 
tis due to a toxic agency of vegetable ori- 
gin. We usually call it "poison ivy," and 
let it go at that. Hot cloths wnmg from an 
epsom salts solution and changed frequently 
are of value. Limewater is serviceable ; so 
is a weak solution of ammonia. Sweet 
spirits of niter used freely at the beginning 
of an attack is thought by many to be abor- 
tive. It may be employed full strength or 
diluted. If there is much "weeping" astrin- 
gent solutions are indicated. Salves and 
powders are as a rule unsatisfactory. 



Hoarseness of public singers and speak- 
ers is improved by taking ten drops of 
dilute nitric acid in plenty of sweetened 
water three or four times daily. It is said 
that more immediate relief may be obtained 
by putting three or four drops on a square 
of loaf sugar and allowing it to dissolve 
slowly on the tongue, inhaling it into the 
lungs. 



Styles move in a circle and are sure to 
get by a given point sooner or later. Ac- 
cording to the daily prints babies are be- 
coming fashionable among the aristocratic. ^ 
It is said that 135,000 babies were bom in 
New York city last year, and that the im- 
mensely rich and favorably environed con- 
tributed their share. This is a great in- 
crease — ^nearly 25 per cent.— over preced- 
ing years. The famous Fifth avenue has 
often borne the reproach of absence of 
babies — a reproach not altogether deserved, 
since that thoroughfare is inhabited mainly 
by bachelors, old maids, widows, widowers, 
and elderly people whose children are 
grown up. But even in aristocratic circles 
we are told that the stork is gaining in 
popularity. 



A WORTHY EKTEHPSISE— A N£W KIND 
OF HOSPITAL. 

An experiment to demonstrate the feasi- 
bility of a plan to wipe out the centers of 
tuberculosis infection in the tenement dis- 
tricts of New York and other cities, has 
been undertaken by the New York Asso- 
ciation for Improving the Condition of the 
Poor. An entire section of the East River 
Homes, more familiarly known as the Van- 
derbilt Tenements, has been leased for three 
years and has been converted into a home 
hospital. In this new institution the Asso- 
ciation has begun a new experiment in the 
home treatment of consunftptives and the 
relief of persons suffering from the dis- 
ease. Into each of the twenty-four apart- 
ments will be moved a family which is de- 
pendent because of tuberculosis and which 
has been under the care of the Association. 
For the next three years an effort will be 
made to determine whether the spread of 
tuberculosis can be checked and cures af- 
fected under medical direction, aided by 
competent nursing, adequate relief, freedom 
from worry, fresh air and sunshine, and 
room for reasonable segregation. In this 
way the Association hopes to get near the 
home of the poor consumptive. 



In every case of hemorrhoids look for 
congestion of the liver. 



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OLIVER WENDELL HOLMES. 

Of a great number of men who have left 
their names indelibly impressed upon the 
pages of histpry, one of these whom our 
fraternity should be pleased to honor is 
•Oliver Wendell Holmes. He was a litcr- 
atus in its broadest significance. He is 
known to the world mainly as a writer and 
poet, although as a physician and scientist, 
for his time, he deserves America's ever- 
lasting encomiums. He is usually accred- 
ited for first having pointed out the char- 
acter and infectiousness of childbed fever. 
While he did not long practice medicine, 
yet, being a lecturer in the greatest medical 
institution the country aflforded, his teach- 
ings went forward in the hundreds of young 
men who drank knowledge at his feet. 

It required what we would now term 
"nerve" and a wonderful personality for a 
man like Holmes to get so healthy a grip 
on life and develop himself into the opti- 
mist that he did in view of his morbidly 
Puritanical environment. His father was 
a preacher of the old, old.school — the kind 
who believed in self-abnegation and drag- 
ging out a miserable, colorless life in order 
that a better one might be insured in the 
hereafter. It was a period of ascetisicni 
and the rigid doctrines were lived up to 
with a keen and abiding faith. Non-church- 
goers were made horrible examples of to 
other unrighteous individuals; sometimes 
derelect worshipers were put in cages like 
squirrels in public places and the object les- 
son impressed upon would-be delinquents 
was, "Now will you be good?" These are 
extreme and striking examples of the spir- 
itual status of things when Holmes was a 
little lad. It was the parental plan that 
young Holmes should follow in his father's 
footsteps and dispense this same caloric 
brand of orthodox religion. In fact, his 
first year in college was spent with that end 
in view, but he broke away from it and 
took up the study of law, this soon being 
abandoned for medicine. Holmes would, 
by reason of his peculiar talents and in- 
domitable will, have distinguished himself 
either as a preacher or lawyer; but it 
seems that his lines were cast where hu- 
manity was most benefitted. 

As a writer and poet he dispensed smiles 
and good cheer, he taught moral living and 



clean thfinking, he formulated practical and 
philosophical rules of living that would ap- 
peal to all who needed help and encourage- 
ment. Holmes recognized the psychic 
wants and desires of sick people as did no 
other physician in his day and age. To 
him is due some of the credit of bringing 
the practice of medicine out of a befogged 
and semi-superstitious age and putting it 
on the semblance of a scientific basis. 



THE ABUNDANCE OF WIDOWS. 

Births average no boys to loo girls. 
The widow crop is, however, much more 
abundant than that of widowers. The ex- 
planation is thus: Men die in the propor- 
tion of 54.4 per cent, and women 45.6 per 
cent. The death rate among males there- 
fore exceeds the birth rate ratio. 



FLATULENCE— ACUTE ATTACK. 

In acute attacks of flatulence, hot water, 
with aromatic spirits of ammonia and spir- 
its of chloroform, with perhaps a teaspoon- 
ful of brandy, often relieves the tension 
and spasm. Sometimes a drop or two of 
oil of cajuput in mucilage has a very good 
effect. 

In cases in which it is possible for the 
patient to follow such advice we may rec- 
ommend riding on horseback or traveling, 
sea-bathing for young subjects, or a voy- 
age, as the best means for completing the 
cure and preventing a recurrence of the 
lymptoms. 



SODIUM SALICYLATE. 



Dr. Finley Ellingwood, of Chicago, III., 
says: "Sodium salicylate, ordinarily used 
for rheumatic conditions alone, is a rem- 
edy the full scope of the action of which 
we do not yet understand. Its influences 
upon the mucous membranes of the nasal 
passages and the ears has been remarked 
upon. Its influence in controlling orbital 
cellulitis is in line with the specific action 
of the remedy in controlling orbital head- 
aches, for which we have used it for many 
years." 



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THE PRACTICAL APPLICATION OF ELEC- 
TRICITY AS A THERA- 



By J. R. Etter, M.D. 

EDITOBIAL NOTE. — Under the alcove caption the 
following introdactory remarks will be followed 
by a series of short, practical articles, and 
while each article wlU be complete in itself, the 
■eries combined, will form a regular vade-mecum 
on "The Practical Application of Electricity as 
a Therapeutic Agent." Theie articles will be 
something dUTerent, that is, they will be pre- 
sented in a dUTerent form from the general mn 
of matter hitherto brought out on the subject in 
the books. No general practitioner can afford 
to miss a single number of THE SUMBCABY 
containing this Series, which will run through 
all the present year and probably the next, and 
will give the technique of application minus the 
theory. 

Electricity, the power that moves 
the world. Electricity, that mystic some- 
thing which we cannot analyze, we cannot 
tell its chemistry, its anatomy, its physiol- 
ogy, its "ions." Yet we have learned to 
harness it so as to make it do our will. We 
light jour houses, we light our streets, we 
cook our meals, we send messages by tele- 
graph to distant friends, we talk over the 
telephone and know the voices of our loved 
ones. We are whirled from place to place 
at tremendous speed on the electric car, we 
cable across the briny deep, we talk to 
people and see their faces at the same time, 
we hear the voice of those who have passed 
to the other side, — through the phonograph, 
we recognize it. We hear great singers, 
tragedians, scientists and others who have 
long since passed from this sphere of ex- 
istence, the same having been recorded in 
a phonograph. The wonderful printing 
presses that grind out their tons of reading 
matter each day, the ponderous machines 
that makes the implements of the artisan, 
the workshops and the mines, are all un- 
der tribute to electricity. And last, but not 



least, it is one of the most certain and ef- 
ficacious remedies for human ills that we 
have in our armamentarium. It is not a 
cure-all, but it has its field, a field that 
cannot be supplied so well by any other 
agent. 

It is not my intention to enter into a 
scientific discussion of electricity, lest I, 
like many who have attempted it before, 
will leave my readers in deeper mystery 
than I found them. I have studied electric- 
ity in many of its fields of usefulness, such 
as electric light, railway, telegraph, tele- 
phone, and other places where it has been 
used in the arts. ^ For twenty years I have 
used it in medicine, and I shall limit my 
remarks to the practical application of elec- 
tricity as a therapeutic agent, or, more 
properly speaking, to the many little things 
that go to make up the technique of its ap- 
plication at the bedside. There are many 
elaborate works written along theoretical 
lines, to which the reader is respectfully 
referred, if he desires to know how many 
different theories there are on the same 
points, but at the same time their mark is 
so high they entirely overlook the practical 
points that go to make up the successful 
practitioner of electro-therapeutics. 

One writer, being anxious to give his 
readers positive and exact information as 
to electricity, defines the "atomic unit," as 
he is pleased to call it, "about the hundred 
trillionth of a coulomb." Again, in order 
to state clearly the attractive power of elec- 
tricity, he says, comparing it with the law 
of gravitation, it is "ten thousand million 
million million times greater." I give space 
to the above statements that my readers 
who have a sufficiently elastic imagination 
to comprehend such a string of incompre- 
hensible figures, may know the exact facts 
about the whole subject. How sad he would 
be if some day he should wake up and find 
that some fertile brain had demonstrated 



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THE MEDICAL SUMMARY 



the fact that he had missed his calculation 
a few hundred times. 

There is a '*knack" in using this agent — I 
can think of no better word to use — that 
has far more to do with its success than 
all the finespun theories that so far have 
been promulgated. In conversation with 
many hundreds of physicians I find that 
the almost universal stumbling-block is to 
get their patients to use electricity, or at 
least to persevere in its use long enough 
to obtain beneficial results. This may be 
explained, to some extent at least, from the 
fact that its mystery has opened a large 
field for charlatans to prey upon the public, 
promising immediate and wonderful cures. 
They ignore all other therapeutic agents, 
and promise speedy cure of everything 
from an ingrowing toenail to cerebrospinal 
meningitis. Then there are many reputable 
practitioners who have delved through the 
technical works on the subject until their 
brain is so muddled as to the whys and 
wherefores, without finding the "hows" or 
the immediate way to supply it to their 
patient, that in their bewilderment they 
shock their patient so severely at the first 
treatment that they will not give them a 
second chance to try their wonderful skill, 
and thus another one is added to the list of 
those who have no faith in electricity, — in 
fact, I might say two, the doctor and the 
patient. After patients have had one or 
two experiences of this kind, it is very 
hard for a man skilled in its use to prevail 
on them to try it again. I sometimes won- 
der, when I hear the harrowing tales they 
tell, that they could be induced to try again. 
In such cases it is often necessary to give 
several treatments so mild as to be of little 
benefit, to regain the confidence of the pa- 
tient, and this is a part of the "knack" 
spoken of above. When a patient comes 
into your ofiice, and, after a careful exami- 
nation, you find enlarged glands or some 
deposit about a joint, and you suggest the 
use of electricity, but he will tell you that 
Dr. So-and-So had treated him for months 
with electricity without any benefit, and 
when you inquire into it you find that he 
had been using a faradic current to per- 
form cataphoresis with, and of course had 
failed. If a surgeon were to perform an 
amputation, he would most likely use an 
amputating knife and bone saw, but ii he 



were to perform a laparotomy, it is prob- 
able that these instruments would not en- 
ter into his armamentariimi ; and it is the 
same way with electricity— one must ha^e 
the proper tools to do the several kinds of 
work, or he will surely fail. Any agent 
that is powerful for good is also powerful 
for evil when improperly used, and elec- 
tricity is no exception to the rule. 

In this series of articles I shall not at- 
tempt rhetorical feats, nor will I burcfcn 
Summary readers with technical words 
uid phrases that so abundantly abound in 
the electrical field, but will endeavor to 
Shy what I have to say in such language 
that the ordinary intelligent man can un- 
derstand what I mean, without having a 
dictionary at hand as he reads. 

Crawfordsville, Ind. 



DIAGNOSIS AlfD TREATMENT OF PELVIC 
INFECTION. 

By E. E. Perisho, M.D. 

The diagnosis and treatment of pelvic 
infection has been quite an interesting sub- 
ject to me during the past few years. My 
experience in a Jarge nimiber of cases has 
caused me to believe that this is one of the 
important diseases of the day, and for a 
physician to be able to say that a patient 
has pelvic infection, without knowing the 
kind of bacteria causing the trouble, is of 
but lin!e use to either the patient or the 
physician, as I believe the treatment and 
outcome of the case depends largely npon 
this question. 

My object in presenting this paper will 
bt my endeavor to arrange the clinical 
symptoms of pelvic infection in such a 
manner that a distinct differential diag- 
nosis of the two most common kinds of 
infection we have to deal with can be made 
before operating, viz.: gonococcus and 
streptococcus infections of the tubes, and 
lliat we may be able to treat our cases on 
a safer basis than we could otherwise do 

All operators as well as general practi- 
tioners recognize that the severity and 
mortality of the case depends largely upon 
whether or not the infection is due to 
streptococcus or gonococcus. The records 



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THE MEDICAL SUMMARY 



of all hospitals show the majority of the 
deaths that follow operations for the re- 
moval of pelvic masses is where the bac- 
teriological examination proved the infec- 
tion to be due to streptococcus. Almost all 
the cases operated on with gonococcus in- 
fection made a good recovery. 

With these facts in mind, I know of but 
few other diseases that cause the average 
man so much uncertainty as to just what 
line of treatment to advise. The puzzling 
question is, should this patient be operated 
upon or not? If so, when and what opec- 
.*<ion should be done? 

If it is a streptococcus infection, and an 
abdominal removal of the mass is done, the 
patient is quite sure to die. If a gonor- 
rheal infection, the mass can be removed 
and the patient will live and make a good 
recovery. The keynote then is to deter- 
mine what is the infection causing the 
trouble. This, in the past, has usually been 
done at the time of operation, by obtaining 
a culture of the pus, but that is rather too 
late to be of any special benefit to the 
patient. 

There is usually no external secretions 
obtainable that can be relied upon, and as 
yet we have no reaction agent, like tuber- 
culin, to make the reaction tests, so our 
diagnosis must be made from a clinical 
standpoint if it is to be of any value in 
saving the life of the patient. The clini- 
cal and pathological, as well as the experi- 
mental study of these two infections, has 
been so extensively investigated that al- 
most all of our standard modem text-books, 
as well as numerous articles in the litera- 
ture, give separate and distinct clinical 
symptoms for each infection, so that the 
great majority of all cases should be quite 
positively diagnosed as to the kind of in- 
fection we have to deal with, before oper- 
ation. 

I shall limit my clinical description to 
these two infections, as the various hos- 
pital records, where bacteriological exami- 
nations have been made, prove that they 
constitute about 93% of all the cases, and 
the remaining 7% are due to other bacteria, 
such as the streptococcus albus and aureola- 
tus coli bacilli and pneumonococci, but as all 
of these latter bacteria produce almost the 
same clinical and pathological conditions as 
the strcptecocci, they will come under that 



classification. So that the object of thi:> 
classification will be to differentiate clini- 
cally between the germs that are confined 
to the mucous membranes, producing pyos- 
alpinx or a localized abscess, and the germs 
that penetrate the walls of the uterus and 
tubes producing metritis, perimetritis, or a 
diffuse septic peritonitis. 

In a series of 3000 cases reported by Dr. 
Hyde in the American Journal of Obstet- 
rics, 1908, he found only 456 cases or 6% 
due to other infections. The bacteriologi- 
cal examinations of E. Raymond, Magill, 
Howard Kelly, and others, are of about the 
same per cent. I find that all the various 
bacteriological records of these cases prove 
that about 55% of the chronic cases are 
sterile at the time of operation, 25% due to 
gonococcus, 12% to streptococcus, and 6% 
to 7% due to other infections. It is esti- 
mated that the majority of the 55% of ster- 
ile cases were probably originally a gon- 
ococcic infection, which makes about 70% 
or more of all cases due to gonorrhea. 

It is a well-known clinical fact that in 
chronic infection of any hollow organ the 
pus is usually sterile, even when it had 
been decidedly infectious during the acute 
stage, but there is a great difference as to 
the persistency of the virulence of different 
germs. 

The gonococcus usually becomes sterile 
in about one to three months ; the virulence 
of streptococcus usually persists for a much 
longer time, or indefinitely. Miller reports 
a case where the streptococcus persisted fcr 
six years; Martin, of Berlin, states that 
streptococcus has been found fully virulent, 
in a pelvic inflammatory mass, after nine- 
teen years. Crossen, of St. Louis, says 
automatic sterilization of streptococcus ab- 
scesses is perhaps possible, but it is so rare 
that it can not be relied upon. He further 
says a streptococcus mass in the pelvis is 
always dangerous and abdominal section 
for the removal of the same, at any time, 
is apt to be followed by fatal peritonitis. 

The clinical differential diagnosis of the 
two infections is made on two points, name- 
ly : 1st, the mode of onset, or the early his- 
tory of the infection; 2d, on the location 
and extent of tissue involved. 

The gonococcic infections are preceeded 
by a history of gonorrhea; that is, a spon- 
taneous purulent lucorrhea, urethritis, caus- 



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ing a burning on urination, and an abscess 
of the vulvo-vaginal glands, etc. Oftimes 
there has been no apparent cause or symp- 
toms previous to the tube trouble, as a 
woman may have a mild attack of gonor- 
rhea without her knowledge of it. Gonococ- 
cus will invade the normal uterus and tubes 
without producing any external irritation. 
It is considered to be the only germ that 
can or does invade the normal uterus and 
tubes of the adult. There are a few cases 
recorded where streptococcus has been 
found in the tubes of young girls, but none 
has ever been found in the adult, where 
there has been no pre-existing external 
disease. 

The location and character of the pelvic 
trouble is almost diagnostic of itself. The 
extension or spread of the gonorrheal in- 
flammation is almost invariably along the 
uterine mucosa into the tubes, toward the 
ovary, into the peritoneal cavity. Gonococ- 
cus almost never penetrates through the 
uterine or tube walls into the connective 
tissue of the parametrium; even when it 
does get into the connective tissue, it does 
not form an inflammatory mass, or a gen- 
eral peritonitis. 

Various experiments have been made by 
injecting pure culture of gonococcus into 
the connective tissues, but no decided in- 
flammatory reaction has resulted. The lit- 
erature contains a very few cases of para- 
metria! abscesses that have resulted from 
* gonorrheal infection 

If gonococcus pus is forced through the 
fimbrinated end of the tube into the ab- 
dominal cavity, it produces a localized ab- 
scess instead of a general peritonitis, as 
does the streptococcus. The mass due to a 
gonococcic infection can usually be pal- 
pated along the tube and outlined distinct 
from the uterus. It is usually situated 
rather high in the tube and ovarian region ; 
it has a soft elastic sensation, and a round- 
ed outline, or, if large, it may be prolapsed 
into the cul-de-sac. There is usually a dis- 
tinct groove, marking the point where the 
mass and uterus come in contact. 

The onset of the acute stage is usually 
mild, the acute inflammatory condition 
subsides in one to three weeks to run a 
more or less chronic course with repeated 
subacute attacks. 

In the streptococcus cases, the inflamma- 



tory mass can nearly always be traced to 
sepsis following labor or a miscarriage. 
The infection may be due to a curettcment 
or other intra-uterine operations or treat- 
ments. Streptococcus infection does not 
spontaneously penetrate the healthy non- 
puerperal uterus, as does the gonococcus. 
In other words, there is always a distinct 
uterine affection preceding the attack. If 
the pelvic mass can not be traced to some 
such a history, it is safe to say that it is 
not due to streptococcus. Not all the puer- 
peral cases are due to streptococcus, as the 
bacteriological examinations, in various 
hospitals, show that about 25% of the cases 
of puerperal infection are due to gonococ- 
cus, but they are usually of a mild type and 
run a short course. There is usually a 
history of a preceding gonorrheal infection, 
but not always, as the gonococcus may lie 
dormant in the glands for a long time fol- 
lowing an old infection or exposure. A 
search should always be made about th« 
external genitals for evidence of old gon- 
orrhea, and signs of previous inflammation 
of the urethra, of the vulvo-vaginal glands, 
red spots, etc. Even then negative findings 
do not exclude the gonorrheal infection. 
The location and character of the mass 
will then have to be relied upon for a diag- 
nosis. 

The streptococcus penetrates the wall of 
the uterus and tubes, and spreads through 
the connective tissues into the surrounding 
parametrium, and it is not confined to the 
mucous tissues as is the gonococcus. The 
mass is of an inflammatory nature in the 
connective tissue outside the tube and uter- 
us./ It is usually in the broad ligament and 
low down beside the uterus into the pelvis, 
and blends with the uterine walls as if it 
were an outgrowth or a part of the uterus. 
It is hard and dense, oftimes simulating a 
cartilaginous or bony tumor. 

Occasionally we find a case that gives a 
history of a gonorrheal infection, in addi- 
tion to a well-defined puerperal infection, 
where the pelvic findings may resemble a 
combination of the conditions I have de- 
scribed so that it might be called a mixed 
infection; but in all such cases, for the 
safety of the patient, it should be regarded 
as a streptococcus infection. Howard Kel- 
ly says mixed infection of two or more 
organisms are rarely found. 



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73 



A differential diagnosis of a pelvic infec- 
tion of the uterus and tubes, or both, from 
a ruptured eptopic, with a hematoma should 
be kept in mind. The pelvic infection usu- 
ally has a preceeding history of some in- 
fection, and the clinical condition is that of 
an inflammatory nature, while in eptopic 
there is usually a history of sterility, irreg- 
ular menstruation, with no pre-existing in- 
fection. The attack comes on suddenly 
with severe pains of almost unbearable na- 
ture, causing more or less of a shock or 
collapse. There is no febrile or inflamma- 
tory disturbance for several days follow- 
ing the attack. 

Tubercular infection of the uterus and 
tubes occurs quite often, but it is usually 
secondary to disease elsewhere ; progresses 
slowly and insiduously, so that there is not 
usually much difficulty in differentiating it 
from acute pelvic infection due to other 
organisms. 

The treatment for all acute pelvic infec- 
tions is absolute rest in bed with ice packs 
and free elimination until all the active 
symptoms have subsided. The large ma- 
jority of all cases will subside and the pa- 
tient will go on with an apparent complete 
recovery. Spontaneous rupture of pus tubes 
into the peritoneal cavity with fatal peri- 
tonitis, is so rare that almost all surgeons 
regard it safer and better to follow the 
rest and conservative treatment. 

Dr. Bonney, of Denver, in the November 
Journal of Surgery Gyneology and Ob- 
stetrics, reports a case of ruptured pyosal- 
phinx, in which article he says he made 
an exhaustive search through the litera- 
ture and found only 31 cases up to June 
1st, 1909. He then wrote personal letters 
to fifty surgeons, asking them for their 
experiences. Out of this number only nine 
had seen a case, who reported a total of 
thirteen cases. 

It is, therefore, safe to say that rupture 
in these cases is of very rare occurrence as 
compared with abscesses of the appendix 
and other organs, and need not be feared 
by the physician while waiting for the in- 
flammation to subside. 

The early removal of the tubes and 
ovaries is not practiced as it was a few 
years ago. Many say that no abdominal 
operation for the removal of the mass 
should be done for at least three months 



following the acute attack, even in the gon- 
norrheal cases, as it is now known that the 
streptococcus cases have a tendency to sub- 
side so that the patient will need no oper- 
ative treatment; while about 50% of the 
gonococcic cases run to chronic debility. In 
the streptococcus cases, where the mass is 
of a hard cartilaginous inflammatory na- 
ture, with dense adhesions binding the mass 
to the uterus, it should probably never be 
operated upon, or if so, with great precau- 
tion, as it is usually very difficult and dan- 
gerous to try to enucleate the mass from 
the uterus. If the mass and adhesions dis- 
turb the patient's health so as to demand an 
operation, a complete hysterectomy should 
be done in these cases. 

If the case is of a gonorrheal nature, and 
has become chronic with repeated attacks 
so as to cause corvsiderable discomfort and 
poor health, the abdominal enucleation and 
removal of the pus sacs can be done fairly 
easily and with a fair degree of safety to 
the patient, with a complete restoration to 
good health. But no abdominal removal of 
the diseased tubes should be done until sev- 
eral weeks after the acute stage has sub- 
sided. If the operator will refrain from 
operating on cases following abortions, 
parturitions, or intrauterine applications, 
etc., where there has been quite an active 
infection with a dense hard mass binding 
the broad ligament and tube to the wall of 
the uterus, the mortality will be very much 
smaller than it has been in the past, espe- 
cially with the amateur surgeon. 

If during the acute or subacute attack, 
there is a collection of pus that can be 
reached and evacuated by a vaginal drain- 
age, it should be done. If this cannot be 
done, it may be drained extra peritoneal 
above pouparts ligament, but due care 
should be taken not to open the pus sac into 
the peritoneal cavity. 

Extra peritoneal drainage should be done 
any time in any kind of infection whenever 
a pus collection can be reached. Very of- 
ten the patient will make a complete re- 
covery, so that no further operation will 
be needed. 

The two following cases will well illus- 
trate the clinical conditions I have describ- 
ed: Mrs. S., age 25, married six years, 
(wife of a saloon-keeper, who gave a his- 
tory of gonorrhea one year after marriage) 



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THE MEDICAL SUMMARY 



mother of one child five years old, had one 
miscarriage four years ago with normal 
recovery, after which she contracted gon- 
orrhea. Three years ago she was sick and 
in a hospital with pains in her side and 
fever for two weeks. This subsided so 
that she was able to do light housekeeping. 
There had been a constant soreness in both 
sides since this time, and always very pain> 
ful during each menstruation. June ist, 
1908, she was taken sick with severe pains 
in both sides and tender to pressure, tem- 
perature 103; vaginal examination revealed 
a large rounded elastic mass out toward the 
distal end of both tubes, very tender to 
touch. It could be outlined distinct from 
the body of the uterus. The temperature 
and active symptoms subsided in about 
three weeks. One month later the abdomen 
was opened and both .tubes were found 
bound down by numerous adhesions, which 
were loosened up and the right tube, con- 
taining about one otmce of creamy pus, was 
removed, leaving the ovary. The left tube 
contained a large abscess involving both 
tube and ovary, necessitating complete re- 
moval of both. Patient made a prompt re- 
covery. 

Case 2. — Mrs. F., age 30 years, married 
eight years, mother of one child, seven 
years old; one miscarriage five years ago, 
which was followed by a fever and sore- 
ness in the abdomen, since which time she 
has never been well; complained of pains 
in her sides, and severe pains on menstrua- 
tion. She had taken local treatment from 
local physicians for years without relief. 
September, 1908, was taken sick with se- 
vere pains in both sides and tenderness 
over lower abdomen; temperature 103. On 
examination a hard dense mass was fotmd 
each side of the uterus, and extending to 
both tubes. The uterus and tubes could not 
be separated, all seemed one hard mass. 
Vaginal drainage was advised but refused. 
All active symptoms subsided in two weeks, 
leaving the hard mass, which was immov- 
able and hard to touch. After temperature 
had remained normal one month, the ab- 
domen was opened to find the uterus and 
tubes bound down with such dense adhes- 
ions that it was very difficult to separate 
the mass from the neighboring organs. 
After the adhesions had been broken up, 
the intestines were carefully packed away 



with lap sponges, and the right tube, con- 
taining a hard inflammatory mass with a 
pus sac, was dissected away from the 
uterus without liberating any of the pus. 

The left tube was surrounded by a hard 
mass attached to the uterus and broad lig- 
ament, so as to make it dithcult to recognize 
and separate the parts. In my efforts to 
separate the organs, and enucleate the 
mass from the uterus, I opened into a pus 
pocket, which was carefully cleansed out 
so as to prevent any of the pus from con- 
taminating the field of operation. The 
mass, including tube ovary and broad liga- 
ment, was removed. Vaginal drainage was 
introduced, also gauze drainage left in the 
abdominal incision. Patient died the fourth 
day from peritonitis. 

Bacteriological examination was not 
made, but from the numerously reported 
cases of this kind that have been examined, 
it is safe to say it was a typical streptococ- 
cus infection, which I should have drained 
by vagina, and this would have been dif- 
ficult as there was but little pus. The en- 
tire mass seemed to be of an inflammatory 
nature. A hysterectomy should have been 
done in this case, if any operation. This 
could have been done without liberating 
the pus, which was spilled in trying to sep- 
arate the mass from the side of the uterus. 

Other cases where I have found the mass 
involving the uterus and parametrium, so 
as to look suspicious, I have had an assis- 
tant make a vaginal drainage while I as- 
sisted by holding the mass down and direct- 
ing the course of the vaginal puncture, and 
have closed the abdomen with all adhesions, 
etc., left undisturbed, with good recoveries. 

Streator, 111. 



SCIATICA. 



Sciatica being an intractable affection, it 
has many remedies for its alleviation and 
many methods of employing them. When 
relief follows we are prone to attribute the 
benign reaction to the last remedy employ- 
ed. As a palliative measure the spraying 
of the limb over the sacrosciatic notch with 
sulphuric ether usually gives gratifying re- 
sults. A common atomizer may be used 
and the finer the spray the more rapid wiD 
be the freezing effect. 



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DISEASE AlfD OLD AGE. 

By J. L. Wolfe, M.D. 

When man reaches the zenith of his 
physical existence, he does not stand a per- 
fect physical man, but already a hereditary 
predisposition, or the struggle of life for an 
existence, or habit of vice, has laid the 
hand of decay upon some one or more or- 
gans of his system, so that he starts down 
the declivity of his existence under disad- 
vantages. Until the climax of physical ex- 
istence is reached, the natural tendencies of 
the organism is to combat disease, but as 
soon as the point of descent is reached, 
conditions change, a retrograde progress 
is commenced, and as life recedes and vi- 
tality diminishes, just in the same propor- 
tion does the body lose its power of re- 
sistence. At this time certain changes set 
up in the physical economy known as in- 
volution which are not yet visible on post- 
mortem examination except by the micro- 
scope. As to what these changes are there 
are several theories. 

One reason that the senile change is resi- 
dent in the nature of the cell which holds 
within itself the conditions of its life, that 
in mankind there is a constant molecular 
renovation, the cessation of which in old 
age cannot be explained. Another writer 
thinks that at the climax of life the plastic 
or formative force begins to grow weaker, 
and that it changes its object in the gener- 
ation of pseudoplasma. Still another thinks 
that the essential feature of senility is the 
quality and quantity of the interstitial nu- 
tritive material, the cause of which change 
he finds in an alteration in the conditions 
of the circulation, induced by the atheroma- 
tous process. 

Whether this condition exists solely in 
the cells, or in the plastic, or in the inter- 
stitial nutritive material, we know that it is 
general, affecting every part of the body. 
The flesh is shrunken, the skin is wrinkled, 
the nails and bones become fragile, the hair 
white, the frame bent, everything denoting 
decay. The arterial system becomes ather- 
omatous, a fatty and calcareous degenera- 
tion extending from the capillaries through 
the entire arterial system involving the 
heart, the right side of which, especially, 



suffers from a disordered nutrition be- 
cause of a sclerotic condition of the coron- 
ary arteries. This produces a sluggish cir- 
culation, to overcome which and restore a 
circulatory equilibrium the action of the 
heart must be quickened and strengthened, 
which results in cardiac hypertrophy. 

The chest walls are wasted from an ab- 
sorption of the fat, and a changing of the 
cartilaginous substance into bone causes 
the whole of the chest wall, the sternum 
and the two sides to act as one piece in 
respiration. The apex beat is much more 
pronounced and located lower down, gen- 
erally between the sixth and seventh ribs. 
Old age is an indefinite term since those 
conditions which go to make up old age are 
often prematurely produced by hardships, 
dissipation and exposure in early life. A 
man may suffer from the effects of old 
age at fifty, or because of a rugged body 
and discreet life it may be postponed until 
eighty. Instances of premature senility are 
abundant at the present day, and are rap- 
idly increasing with each generation, while 
instances of death from a wearing out un- 
complicated by disease are few. 

Extremely fortunate is the child of 
healthy parents, born into the world with 
a sound and vigorous body, reared by in- 
telligent and thinking guardians, for here 
the treatment of disease and old age must 
begin if successfully practiced. In that 
perilous time of life, youth and young man- 
hood, the foundation for a long and healthy 
life must be laid, but how disproportionate- 
ly large the majority who strand at this 
stage of life. 

Treatment of disease in the aged should 
be different from what it would be in adult 
age. First, caution should be taken in 
diagnosis of the case, because of complica- 
tions which are almost sure to be present, 
having been induced by the wear and tear 
of years of activity and toil. All applica- 
tions and drugs should be avoided which 
tend to weaken the action of any vital or- 
gan. 

Cedar Falls, Iowa. 



The best combination for mild counter- 
irritation over chest or abdomen is turpen- 
tine and soap liniment, equal parts, sprin- 
kled on warm flannel — ^with or without oil- 
silk, or thin rubber tissue covering. 



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PROGNOSIS AMD TREATMENT OF PLA- 
CENTA PRAEVIA. 

By a. D. Hard, M.D. 

The prognosis of ordinary form of mar- 
ginal praevia is favorable if the patient has 
not already lost enough blood to weaken 
her ability to bear the measures needed to 
give her relief. About eight per cent, of 
all cases that are treated in a hurry without 
complete asepsis become infected and suc- 
comb to septic fever. The great majority 
of all cases escape septic infection even 
though nothing is done to prevent it. Prog- 
nosis depends almost altogether on the 
amount of hemorrhage at one time. If a 
woman of 140 pounds loses seven pints of 
blood in 24 hours, she will usually die. 
Prognosis in any given case also depends 
upon rapidity of hemorrhage. Four pints 
lost in 30 minutes will be as dangerous to 
life as six pints distributed over six hours. 
Prognosis also depends upon the prompt- 
ness and efficiency of the physician. An 
easy-going doctor who treats his cases on 
the expectant plan — expect them to recover 
on any old treatment — ^will lose almost all 
of his cases of placenta praevia. The re- 
sourceful physician who acts, and acts 
quickly, will save almost all of his cases. 

The treatment consists in stopping the 
hemorrhage. The hemorrhage can best be 
stopped if the uterus is emptied quickly 
and be made to contract. The best way to 
empty the uterus is to dilate the cervix 
with the fingers of both hands so as not to 
insert any one finger too deep inside the 
cervix and open up new sources of bleed- 
ing. The best way to prevent the danger- 
ous bleeding that occurs between pains is 
to give tablespoonful doses of squibb's ergot 
until pains are continuous instead of inter- 
mittent. If the cervix can be dilated quick- 
ly and the head presents, forceps delivery 
is indicated. If the cervix is difficult to 
dilate version is indicated and constant 
traction in order to produce pressure on the 
bleeding surfaces until pains contract the 
uterus. Rapid extraction of the placenta 
by moderate traction on the cord and com- 
pression of the uterus over the abdominal 
walls is demanded. Compression of the 
uterus by the hands of an assistant on the 
abdominal walls is a valuable aid at all 



times. Applications of cold are useless and 
dangerous. Concealed hemorrhage in com- 
plete praevia calls for pushing the hand 
through the placenta quickly, version and 
drawing down one leg only to act as a 
plug to close the bleeding vessels until con- 
tactions can be secured of a continuous 
nature by big doses of ergot. 

In manual work the pat;ent should be 
placed in the lithotomy position across the 
bed, and the limbs be held firmly by twd 
assistants. The closer the thighs are crowd- 
ed down upon the abdomen the better. No 
medicines are to be thought of except ergot, 
and that in tablespoonful doses every half 
hour. This may be supplemented with 
hypodermic injections of ergot in the thighs 
at frequent intervals until pains of a con- 
stant nature are induced. 

Continuous uterine contraction always 
stops the bleeding if it can be secured in a 
pronounced form. Vaginal tampons do 
nothing but dam back the flow in the dis- 
tending uterus and is just as fatal as to 
allow the blood to emerge. Hemorrhage 
into the uterus is exactly the same as hem- 
orrhage into the bed, as far as results arc 
concerned. When the diagnosis is made of 
placenta praevia and bleeding is in progress 
there is no time to stop and think. Act at 
once, and act with decision. Order those 
around you to keep cool and follow your 
directions without questions. Do not waste 
too much time in getting ready. There is 
no time for a great display of tools and 
red tape. Cleanse your hands if there is 
time, but do not let the woman die while 
you are trimming your nails. When you 
give the hypodermic of ergot do not stop 
for aseptic ergot or aseptic syringe. These 
are minor matters of not much importance, 
anyway. Rapid action is the thing to be 
given the most importance. When the work 
is done and the pale and almost bloodless 
woman is out of immediate danger, give 
her half teaspoonfuls of Valentine's meat 
juice every hour and keep her head very 
low. Knead the uterus every hour with the 
hands to keep up constant contraction. 
Give her all the cold water that she wants 
to drink, and she will want a lot. 

In twelve hours she will make three pints 
of new blood to take the place of that which 
was lost. Then look out for sepsis* She 
should be seen very often, as symptoms may 



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supervene with but little notice of their ap- 
proach; Echinacea, sulphide of calcium and 
true calicylate of soda, are the only internal 
remedies, Listerine and boiled water, equal 
parts, make the best possible vaginal or 
intrauterine douche. 
Marshall, Minn. 



CALOMEL IN THE INTESTINAL TROU- 
BLES OF INFANTS.— THE UN- 
SALTED INFANT. 

By Thomas R. Evans, M.D. 

According to one derivation, the word 
calomel is derived from kalos, fair, and 
melas, black, for it is said to have beauti- 
fied the complexion of an African princess, 
hence Ethiop's mineral. 

This reminds one of the fact that citi- 
zens of African descent, at least in my 
knowledge, drink tea and not coffee, as they 
think tea tends to promote a light or tan 
color. The dry form of calomel is made 
through the agency of a mercurous salt 
and chloride of sodium. 

The season for gastro-intestinal affec- 
tions of infants approaches, and there is 
nothing new in the statement that calomel 
is excellent in the preliminary stage of such 
diseases, but when it is stated that it is the 
best remedy the advocates of the new in- 
testinal antiseptics may net agreee with me. 

As a result of the French Revolution 
both calomel and Sunday were done away 
with, but it was soon demonstrated that 
the overworked liver and the overworked 
man required their restoration. 

Calomel is pre-eminent for infants who 
may need it — said to be insoluble, tasteless, 
yet it has a sweetish taste, giving rise to 
another derivation of the word. Its small 
dosage, its weight, tending to prevent re- 
gurgitation, and its property of sticking, 
cause it to be a sovereign remedy. Except 
for convenience of dosage, its compression 
is a mistake, its impalpableness a virtue. 
The soda in the tablet is in too small amount 
for therapeutic effect. The doctrine is that 
soda "directs" the calomel to the liver. 
The calomel and soda tablet should be 
thoroughly pulverized, and an indefinite 
amount of bicarbonate of soda added, and 



a little sugar to prevent the semi-caustic 
effect of calomel on the mouth. When such 
a dose is given, but little calomel is 
required, and no subsequent purgative, pro- 
vided the soda is thoroughly incorporated 
with the calomel. Here the teaching of 
Hahnemann seems true, the finer the pow- 
der and the more intimate the incorpora- 
tion, the more potent the effect. 

Intestinal affections of infants and not 
gastric ones are the chief causes of our 
employment in hot weather. This is due to 
several factors pertaining to the infant's 
stomach. It is a small expansion of a con- 
voluted tube; like a tilted pitcher it easily 
slops over; it sends an overplus, or irri- 
tating matter, up or down. A slight pres- 
sure, or a slight change in the axis of its 
body, will sometimes cause it to spill over. 
Shakespeare's idea of a baby is a thing 
which mewles and pukes in its nurse's 
arms — this makes for health. But when 
matter gets into its intestines it is longer 
retained. 

Salt for the stomach, calomel and soda 
for the intestines. 

It is never recommended to give a breast- 
fed baby an occasional pinch of salt, yet 
this is physiological, particularly when the 
baby is colicked. Its gastric juice is com- 
paratively weak, for the salt for its manu- 
facture is only very indirectly derived. 
Man is a salt-using animal. The digestive 
function in the small intestine is carried on 
in an alkaline medium. The condition of 
the infant in hot weather is apt to be an 
acid one. Heat causes acidity. When acid 
chyme, too pronounced and in large amount, 
is seeped into the infant's intestine, then 
the danger appears. When the acid over- 
comes the alkaline condition of the intes- 
tines, we provoke the alkaline bile, the al- 
kaline pancreatic saliva, and the alkaline 
succus intericus with calomel and soda. 
No poet has sung or can fully sing the 
praises of calomel under such circum- 
stances. 

Huntington, W. Va. 



In case of impacted ear-wax in either or 
both ears, try a little peroxide of hydro- 
gen on a plegget of cotton placed in the 
ear for a few minutes. The results will 
surprise you. 



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THE MEDICAL SUMMARY 



THE RATIONAL TREATMENT OF HYS- 
TERIA WITHOUT MINUTE PSY- 
CHOANALYSIS. 

By Tom A. Williams, M.B., CM., Edin. 

Member Corresponding Society of Xeurolofcy and 

Psycholopry of Paris, Etc. Neurologist to 

Epiphany Free Dispensary, 

Washington, D. C. 

By hysteria is not signified general emo- 
tionalism or nervous excitement, nor will 
consideration be given to cases of simula- 
tion, nor querulous psychosis. And, of 
course, psychasthenia and neurasthenia, as 
well as lower neurone disorders, will not 
enter into the consideration. It is not the 
form or aspect of the symptom which en- 
titles it to the designation hysterical. The 
criterion of hysteria is its genesis, for the 
methods of psychopathology do not differ 
from those of somatopathology in seeking 
an aetiological classification. 

Babinski has brought order from chaos 
by limiting the term hysteria to disorders 
generated by suggestion, and excluding all 
other disorders from this group. The jus- 
tification of this classification has been given 
at length elsewhere*, so I shall not discuss 
it here. I have selected from my records a 
series of casesf which seem best to illus- 
trate how success is to be attained in treat- 
ing hysteria, for they show how a thorough 
appreciation of the part played by sugges- 
tion in aetiology leads to a scientific thera- 
peusis. In this therapeusis suggestion, how- 
ever, plays only an insignificant part; in- 
deed, some of the cases illustrate the failure 
of suggestion as against the success of en- 
lightenment, rational persuasion and reduc- 
tion of the patient's erroneous attitude of 
mind, which are the means of giving the 
patient a relief which is likely to be per- 
menent, whereas the crude Icger de main 
constituted by most suggestive measures, 
even if successful in removing a symptom, 
only accenuates a person's liability to re- 
lapse by further increasing the suggestibil- 
ity* 

For convenience I have divided cases 

into three types: (i) Where the causative 
suggestion is found to originate in some 

^International Clinic, 1908, Vol. HI. 
tMedical Annaal, Waihington, D.O., Jan.. 1912. 



organic disease. This is the commonest 
type and the most practically important, 
because the hysteria often creates far more 
functional disability than does the disease 
which suggests it. 

(2) Cases in which the causative sugges- 
tion was not discovered because of insuf- 
ficient psychoanalysis, but in which the sec- 
ondary effects of the undiscovered sugges- 
tion which had become a habit were re- 
moved by psychomotor discipline, and the 
tendency to further hurtful suggestions was 
minimized by psychotherapeutic measures 
consisting of the readjustment of the pa- 
tient's point of view. These cases are not 
uncommon in practice, are rarely cured 
either by mediate or immediate suggestion, 
and require a knowledge of psychothera- 
peutic technique for their successful treat- 
ment. 

(3) Cases of hysterizability, whether in- 
nate from family predisposition, or acquir- 
ed usually in childhood on account of im- 
proper upbringing and lack of education in 
self-control, and against impulsivity and in- 
attention. These cases are in want of pedi- 
gogical as well as medical assistance, but 
as those who usually come to the doctor, 
do so because their ailment is supposed to 
be physical, the physician must become ped- 
igogue towards those patients, at least until 
the false ideas as to their physical states 
which have arisen from suggestion have 
been transformed. 

It is not necessary to illustrate in detail 
the mechanism by which suggestion pro- 
duces symptoms, for that has been done in 
several preceding communications: The 
Genesis of Hysterical Symptoms in Child- 
hood, Medical Record, 1910; The Function 
of the Neurologist, Medical Record, 191 1; 
Hysteria and Pseudohysteria, American 
Journal of Medical Sciences, 19 10. Besides, 
many of the cases incidentally reveal the 
pathogen of their symptoms. 

1758 K St., N. W., Washington, D.C. 



Anal Fissure. — Anesthetize with cocain 
and apply pure ichthyol. Subsequent appli- 
cations should be made on alternate days. 
Give sulphur in generous doses to keep the 
stools soft and to further promote the heal- 
ing process. 



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SOME SUMMER REMEDIES AKD THEIR 
INDICATIONS. 



By H. Hamilton Redfield, A.B., M.D. 

Professor of Thexapentios in The Bennett Medical 

OoUege, Medical Department of The Ljola 

UniTersity, Ohieago, Illinois. Ohief 

Therapentist to The JelTerson 

Park Hospital, Ohieafo, 111. 



The two cardinal seasons of the year — 
winter and summer — ^presenting as they do 
diseases which are peculiar to themselves, 
should hold a vast store of interest to the 
every-day practicing physician, the com- 
mon "family doctor/' the man out on the 
firing line, not blessed with the latest diag- 
nostic appliances or therapeutic innova- 
tions, the man who must make good, and to 
whom his neighbors are looking for re- 
sults, and not theories. As the winter sea- 
son has its long train of coughs and colds, 
its diseases of the chest and lungs, its rheu- 
matismSy its pneumonias, bronchitis, tonsil- 
itis, etc., so does the summer bring with it 
its following of enteric conditions, its dia- 
rrheas and other kindred affections of 
childhood. The sudden transition from 
cold to warm, often proves a very potent 
factor in the production of conditions not 
met with at any other period of the year. 
The thawing out of garbage heaps, the 
flooding of cesspools and cisterns by the 
excess of surface water from the melting 
snow, the use of milk from unsanitary ves- 
sels, the eating of unripe or decayed vege- 
tables or fruit, all these play an important 
role in the etiology of the diseases of chil- 
dren, peculiar to the spring and summer 
months. The question of dentition is one 
that should be dismissed as unworthy of 
serious consideration, when summing up 
the causative factors in the production of 
the summer diseases of children. 

Before going into a discussion of the in- 
dications calling for the exhibition of any 
of the remedies which are peculiarly adapt- 
ed to the treatment of these summer com- 
plaints, it might be well to review in brief 
the etiology, pathology and symptomatology 
of some of the more common conditions 
with which the physician is called upon to 
cope, after which we can give some atten- 
tion to those remedies which have proven 



their worthiness in thousands of cases, and 
are therefore entitled to a close and careftil 
study. 

The first of these summer conditions 
which the family doctor meets is what is 
commonly known as common diarrhea. 

Synonyms. — Intestinal catarrh, without 
anatomical changes; acuter darmkatarrh; 
diarhee catarrhale; diarrhee idiopathique. 

Varieties. — Lienteric (irritative), idio- 
pathic, symptomatic, diarrhea ablactatorwn. 

Etiology. — Nervous excitement of the 
muscles of the intestines, either simply from 
mental impressions, reflexly, or from irrita- 
tion within the intestines themselves — 
worms, impacted feces, curds, undigested 
foods, ptomaines, toxins, etc.; also critical 
as in certain diseases such as measles, etc. 

Exciting Causes. — Cold, bad hygeinic 
surroundings, fear, anger richitis, intestinal 
worms, impressions made upon the nurse, 
eruptive fevers, wrong foods, decayed or 
unripe food, unclean dishes or nursing bot- 
tles, poor nurse, weaning during the heated 
months, suppressed eruptions, fruit, eta 

Predisposing. — Bad air, hospitals, found- 
lings' homes, uncleanliness, hot weather, 
continued for several days. 

The principal of these etiological factors 
in young children is unsuitable quantity or 
quality of their food conjoined with hot 
weather. 

Complications. — Emaciation, if diarrhea 
is persistent; the skin becomes leaden in 
color, face pinched, and the muscles flabby 
and soft. 

Symptoms. — In the case of children who 
are very strong the symptoms are most 
marked at night, the child sleeps only light- 
ly, it tosses about or cries out in its sleep, 
there may be colic with considerable pain, 
the little sufferer drawing up its legs against 
the abdomen during the paroxysms. In 
the day time the child is fretful, peevish, 
and suffers occasional attacks of colic. 

The early hours of the condition are 
marked by an absence of fever, and the 
nursing is eager. There is difficulty exper- 
ienced in swallowing, and in many in- 
stances regurgitation of curds of milk oc- 
cur. The stools may be thin and watery, 
mucus or phlegm, mixed with undigested 
particles of food, bits of meat, vegetables, 
or lumps of casein. Early the stool is of 
normal color and homogeneous, later they 



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THE MEDICAL SUMMARY 



change to greenish, thin, or gray, rice- 
water stools of summer diarrhea, in which 
event they lose their odor and become 
either neutral or alkaline in reaction, their 
ejection being exceedingly forceful. Gen- 
erally there is moderate distension of the 
abdomen with tenesmus and rumbling in 
the intestines (borborygmi). 

Course. — Recovery as a rule is more fre- 
quent in these cases than it is in cholera in- 
fantum ; generally in one or two days there 
is a change in the character of the stool, 
they becoming more consistent, although 
they may still contain considerable amounts 
of mucus. In other cases, there is a fol- 
lowing constipation, an improvement in the 
appetite of the child, with continuing faulty 
nutrition, and in these cases relapses are 
very common and apt to occur at any time. 
Eventually these are transformed into a 
condition of chronic intestinal catarrh with 
tabes, but this condition may also develop 
directly from a case of acute diarrhea, 
without any intervening relapses. 

Prognosis. — Favorable if checked within 
three or four days, but if allowed to run for 
a longer period the case is very apt to be- 
come transformed into the chronic form. 
A guarded prognosis is by far the safest. 

Chronic Intestinal Catarrh. 

Synonyms. — Enteritis follicularis ; chron- 
ic diarrhea; summer complaint; atrophia 
lactantium ; entero-colitis. 

Symptoms. — An acute diarrhea or an at- 
tack of cholera infantum, ending neither 
in death nor cure, leaves the physical con- 
dition of the body in an extremely unsettled 
or disturbed condition, the discharges re- 
maining persistently thin, acrid and gradu- 
ally taking on typical penetrating odor of 
decomposition. There is excoriation of the 
anus, thighs and buttocks, from the con- 
stant irritating discharges, and there is 
marked distension of the abdomen. In these 
cases we meet exceedingly high tempera- 
ture, and the case is characterized by ex- 
cessive thirst. Moderate drinking of water 
is agreeable, but in many instances it will 
be found that the excessive use of water 
is productive of emesis. Some of these 
cases are marked by excellent appetite, and 
at times abnormal. In spite of the wolfish 
appetite, the child undergoes rapid atrophy, 
until it resembles a walking skeleton, with 



an abnormally tympanitic belly. During; 
this general atrophy the brain also partici- 
pates, the bones of the skull overlap each 
other, i. c, the parietals override the occipi- 
tal and frontal. 

Pathological Anatomy. — There is infil- 
tration of the submucous cellular tissue of 
the entire colon, and a portion of the small 
intestine, the superficial surfaces of which 
show indications of an acute catarrh in the 
loss of its cylindrical epithelium with an 
abundant secretion of mucus. Many of the 
solitary glands and Peyer's patches are 
swollen, infiltrated and have degenerated, 
into ulcers. The glands of the mesentery 
show as enlarged, infiltrated patches, red- 
grayish-white, and the lacteals are injected,, 
with chyle stains. 

Prognosis. — Always serious; generally 
fatal. Apparent cessation of the diarrhea^ 
is not to be considered as always hopefuL 
Catarrh us Gastro-Intestinalis Acutus. 

Synonyms. — Cholera infantum, epidemic 
cholera, acuter magendarmcatarrh ; entero- 
colitis choleriforme. 

Etiology. — Faulty nutrition of the child,^ 
especially apt to occur in summer from 
sour milk, the keeping of milk in unclean 
vessels, bad, improper fodder for cows, 
abnormal irritation due to improper food,, 
fermentation in the intestine, emotional 
excitement. Vaughn gives it as his opinion 
that all cases are due to tyrotoxicon, a poi- 
sonous alkaloid which is formed during the 
decomposition of milk. Brush believes that 
the underlying factor is a toxic substance 
produced in cow's milk by overheating; 
while Brunton states that it is the toxic 
alkaloids produced from the decomposition 
of lact-albumin that produce the diarrhea. 

Symptoms. — In a number of these cases 
a close history will elicit the information 
that for several days the food (cow's milk) 
has been vomited at times, after a period 
of restlessness extending over several days, 
or there may be a sudden onset with only 
a slight alteration in the stools, which are 
passed rapidly, and contain either undigest- 
ed curdled milk or consist of frothy masses 
of a strongly acidulous and penetrating' 
odor. 

After this condition has lasted for hours,, 
there generally occur suddenly, yellowish- 
greenish, watery stools, having a stale, sour 
smell, and numbering from lo to 30 per 



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day. At first "ricc-watery" and very pro- 
fuse, running through the ''napkins" and 
often the bed clothing; later they become 
tinged with blood, and vomiting of all food 
ingested occurs. As the supply of body 
fluids becomes exhausted, by these exces- 
sive stools a condition of serious hemor- 
rhage occtirs causing circulatory disturb- 
ances everywhere in the body. The pulse 
becomes weak, rapid and irregular, the skin 
is cold and clammy, and the amount of 
urine is decreased. The face is senile, eyes 
sunken, cheek bones prominent, the great 
fontanelle sinks in, and the cranial bones 
overlap feach other. In rare cases there 
now occurs a reactive fever, with cure or 
transformation into chronic gastro-intes- 
tinal catarrh. In t3rpical cases, however, 
death generally occurs in from five to six 
days with symptbms of spurious hydro- 
cephalus, characterized by moaning, rest- 
lessness, dilated and immobile pupils, con- 
vulsions, dyspnea from anemia of the me- 
dulla, and marantic thrombosis of the cere- 
bral sinuses. 

Epidemic Colitis. 

An acute inflammation of the mucous 
membrane of the colon, possibly diphther- 
etic in nature, and often epidemic at the 
S2ime time with diphtheria, or intermittent 
fever. 

Etiology. — Occurs generally after an ex- 
ceedingly hot summer, in tropical locali- 
ties, but is rare in children under one year 
of age; after the first year and until the 
fifth year it is very frequent. 

Symptoms. — After an incubation period 
of a week to ten days there may or may 
not occur a chill, followed by a diarrhea, 
which increase in number with great rapid- 
ity, often being as high as fifty in a day, 
and are accompanied with great tenesmus, 
straining at stool and rumbling of gas, 
tingling of the limbs and cramps in the in- 
testines. The stool at first contains small 
masses of fecal matter, but later on become 
glairy, and consist of pure mucus — the 
white of egg passage. In some cases they 
are colored red from colonic hemorrhages, 
this being the true bloody dysentery. When 
diphtheritic destruction of the mucous mem- 
brane occurs, the stools take on an odor of 
decomposition or putrefaction, and are 
mixed with shreds of mucous membrane. 



In the beginning there is either no increase 
in the temperature, or very Htde rise it 
noted, and in severe cases there is always 
a drop in temperature. In the presence of 
ulceration the temperature always rises, 
and may be attended with delirium uid con- 
vulsions. 

In the foregoing no attempt has been 
made to go into the details of these dis- 
eases of the summer months, occurring in 
children, but only to give an ootline of 
their causative factors, for upon this de- 
pends the success of the treatment. 

In the next of these papers we will take 
up. for consideration the general treatment, 
and also the remedies which have proven 
their worth in combating these conditions 
met with in these little patients. 

622 W. 71st St., Chicago, 111. 

(To b« oontinuad.) 

[In the above article. Dr. Redfield pre- 
sents an excellent idea of the etiology, 
symptoms and complications of these sum- 
mer diseases of children. This article will 
be followed by several others on the same 
subject, in which the author proposes to 
take up separately the especial remedies for 
the treatment of these conditions. — Ed.] 



TO YOUNG DOCTORS. 



By D. L. Field, M.D. 



Don't get the idea into your head that 
a patient's stomach is a chemical labora- 
tory. Don't think that the sick. must be 
plied with lots of medicine, and that the 
drug store can be transferred to the sick- 
room. Learn to withhold medicine unless 
there is a positive indication for it. Do 
not forget the restorative power of nature. 
Rest, diet, quiet, cleanliness and good nurs- 
ing, with a mere placebo, will work won- 
ders. The coming years will more and 
more abridge medication as curative, but 
the preventive therapy will become more 
and more practical. The'saying, "an ounce 
of prevention is worth a pound of cure," is 
absolutely true. 

If you do use much medicine, don't mul- 
tiply prescriptions. I was in a hou^e not 



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THE MEDICAL SUMMARY 



many years ago where there had been a 
case of typhoid fever, and the mother of 
the sick man showed me a mantlepiece cov- 
ered with partially-emptied bottles, powder 
boxes, and boxes of capsules. Some of the 
contents of these receptacles had hardly 
been disturbed. She told me her bill for 
prescriptions had amounted to over $60. 
That was criminal vacillation and cruel ex- 
travagance in cost to the patient. 

The importance of definiteness in treat- 
ment, and perseverance in that definiteness, 
is due the sick, and will give good results, 
which will rebound to the credit of the phy- 
sician. While changes may have to. be 
made to meet indications as they arise, yet 
steadiness must be the aim. Young doc- 
tors are prone to place too much reliance 
in the efficacy of drugs, and are "blown 
about by every wind of doctrine," so to 
speak. They are too much given to the 
employment of every new "remedy" that 
may be brought out. They are the chief 
reliance of proprietories. Experience has 
taught me there is nothing that can take 
the place of the time-tried effective medi- 
cinal agents of the pharmacopeia. Let our 
young friends qualify themselves to write 
eligible, compatible and effective prescrip- 
tions from their own acquaintance with the 
materia medica. Do not scatter with a 
blunderbus, but make a rifle shot at the 
seat of disease. Do not have too many in- 
gredients in your prescriptions. Learn to 
simplify your treatment. I knew a doctor 
who put so many ingredients into his pre- 
scriptions that Galen could not have guess- 
ed what he was aiming at. I doubt if he 
knew himself. At all events he could not 
have failed to hit something, but what he 
hit I have no idea. For goodness' sake, do 
not imagine you know a specific for any 
malady. There is no such thing. A phy- 
sician, at best, only assists nature to right 
herself, and time, and but little medicine, 
will generally do the business. 

After forty-five years' practice, I have 
capped off, trimmed and concentrated my 
medicinal agents to a comparatively small 
number. 

Teffersonville, Ind. 



THE FLY. 



In using methylene blue do not confound 
it with methyl blue. 



By J. A. De Arm AND, M.D. 

In our childhood days we were taught 
that every animal was made for a purpose, 
and therefore it was wicked and cruel to 
kill any animal just for the sake of remov- 
ing it from the things that were alive. 
Like as not it was a childish fancy, but the 
application of the lesson was not half bad, 
and even though it may have grown to be 
passe, there is much to admire in the home- 
ly advice. Those people who reason that 
it is wise to destroy those things within 
easy reach whose usefulness in the econ- 
omy of nature is not understood are not 
all rated as "our best people." They are 
the ones who admire the spider because he 
spins his web and then goes to sleep, with 
one eye open, and waits until the bold fly 
wanders into the net. They are the same 
who later on put the same spider out of 
business because perchance his bite may 
prove poisonous. So maybe it is a childish 
fancy, but it seems to be almost reasonable 
that there are no happenchances in nature 
and that nothing is without reason. 

The fly has in later years got in bad with 
scientists, as it always had with bald-head- 
ed men and cleanly housewives. The fly 
has a bill of particulars filed against it 
which make instant death seem the shortest 
way out of its trial. At that it seems only 
fair that somebody speak a good word for 
the fly, even though it be more out of ap- 
parent justice than deep sympathy. 

In our climate, with its moist atmosphere, 
dead animals of all kinds travel the decay 
road slowly. The result is that foul odors 
pollute the atmosphere round about for 
from hours to days and weeks. The odors 
are such that when undiluted by plenty of 
air they are noxious and even deadly pois- 
onous. If the animal condemned to slow 
decay be large it is hardly possible to com- 
pute the extent of air pollution, nor is it 
possible to compute the remote effect of 
that pollution upon the influence of it upon 
the unseen but known microscopic disease 
or disease-bearing germs. We pour into 
our rivers filth of unnamable kinds and 
unbelievable quantity, and then blindly hug 



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83 



to our minds the feeble delusion that the 
natural law by which water in motion tends 
to purify itself will protect us from the 
scourge and pestilence. It is a clear case 
of "out of sight, out of mind.** Science is 
crying from every housetop that the os- 
trich is not the only bird that is covering 
its head with sand and imagining that 
safety is certain. 

But to return to the fly. What is its 
mission? Assume for the sake of argu- 
ment that flies differ principally in the de- 
gree of nuisances the different species per- 
fect themselves in so far as their associa- 
tion concerns human beings. It must not 
be denied that old mother nature sends out 
a call when decay is imminent, and this 
call is never disobeyed. An army of flies 
flock to the scene of action, and between 
mussing around and planting eggs to guar- 
antee the enlargement of numbers the busy 
bee has nothing on the fly brigade. The 
outcome of all this activity is that the per- 
iod of atmospheric pollution is wonderfully 
shortened, and thus we are justified in as- 
suming that less damage is done. Then the 
fly will receive his passports only when his 
day of usefulness and need has gone by. 
That he may carry a variety of forms of 
danger on his filthy feet is warning enough 
for his exclusion from good society, but 
the way to get rid of his kind is to clean 
up so his occupation will be gone. That 
means $25 and costs for the man whose 
prowess encompasses the catching of a 
large luscious rat and then in a display of 
valor slings the same in the street to fur- 
nish a breeding place for millions and mil- 
lions of flies. Other means will suggest 
themselves to the reader. 

The point aimed kt is that the "swat-thc- 
fly" slogan is all right, but it is beginning 
at the wrong end of the case. Swat the 
cause of the fly's existence, and you reduce 
the labor of swatting. 

In many cities our public schools are 
employing medical men to not only single 
out the physical defects that so often mark 
the line between brightness and stupidity, 
and point the way to correct the latter be- 
fore it is everlastingly too late, to seek out 
and correct the dullness of hearing or 
sight which so often act as insurmountable 
^rriers to successful schooling, and in 
short to give all the scholars a chance. The 



work of these medical scouts also is made 
to extend to the examination of nose and 
throat. When cases of diphtheria are found 
in appreciable numbers cultures taken from 
the throats of many children show that 
they are carriers of the germs of that dis- 
ease, although they may not then show any 
of the physical indications of the disease. 
In other words, they are Spartan boys with 
foxes buttoned up inside their coats. They 
are carriers of poison that may enter their 
own systems or may be conveyed to other 
children. Why certain seasons of the year, 
or whether it is that certain poisons pol- 
lute the atmosphere under unknown and 
unrecognized situations time and discovery 
will tell, but it is safe to assume that there 
is some definite relation of cause and ef- 
fect acting by which germs of particular 
kind are born and fostered. 

To all this likelihood there can be no 
definite answer. Time and study will solve 
it as it has the problem of making diph- 
theria, once the most dreaded of children's 
diseases, now the easiest to cure. Of one 
fact we can be sure, and that is that in the 
great work of making people healthier, and 
therefore happier, there never yet has been 
sounded the alarm that people were too 
cleanly or giving too much time and atten- 
tion to making our houses, villages, cities 
and country too clean. 

Davenport, Iowa. 



A GREAT HEALER. 



By W. T. Marks, M.D. 



We are always disposed to laugh at the 
blatant quack and his preposterous claims, 
and wonder why such a large element of 
gullible public is taken in by them. There 
is a popular song about our frivolous and 
off-color acts and how we do them "over 
and over again.** The people who patron- 
ize quacks never get cured of the habit, 
and it seems are always looking around to 
be taken in afresh. There are many, how- 
ever, who will not succumb to the wooings 
of the medicine man on a humble plane, 
but are always beckoned by the healer who 
employs bizarre and picturesque methods. 



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Of the latter type of individual this little 
description relates. 

At St. Elmo, 111., a town of two or three 
thousand inhabitants, a noted healer has 
been holding forth for two or three years. 
He has augmented the business of the 
town in every way, especially its hotels, 
stores and restaurants. A friend who sells 
notions and novelty goods writes me that 
his business has also been helped. I un- 
derstand that Mattoon, a town twenty or 
thirty miles from St. Elmo, offered the 
healer a big bonus to locate there, but the 
professor had ro desire to move. In fact, 
he had more business than he could take 
care of already. He rented the largest 
hotel in the town for an office, and it is 
said that there are constantly in the village 
several hundred strangers who are court- 
l.ig health. 

It is necessary for a new patient to reg- 
ister several weeks ahead in order to get 
an audience with this healer, so great is 
his volume of business. Whether this ad- ' 
vance registering is a trick of the business 
and a trade-getter, I don't know. That he 
has patients (?) from coast to coast no one 
can deny. He has been written up in the 
daily prints, and like all such individuals 
who gain recognition, his advertising goes 
on by its own momentum. 

Last week a press report heralded the 
fact that John D. Rockefeller, he of Stan- 
dard Oil, and incidentally a bum stomach 
and no hair, in disguise consulted this man. 
A reporter called on the healer's secretary, 
who would neither confirm nor deny the 
report. 

Several of my acquaintances and one 
relative have consulted the great healer, 
but they have little to say about it. Cases 
of hopeless chronicity seem to be discreetly 
passed up by the professor. How or from 
what source he gets his ability to differen- 
tiate cases I don*t know. It may be fool, 
blundering guess-work. Again, the man 
may possess a deep intuition or psychic 
power from which he draws. I would 
rather be inclined to think his success due 
to his monumental and never-flagging 
nerve. Then seeing and handling so many 
people daily ought to give him a vast 
amount of experience in the matter of ac- 
cepting and rejecting patients. 



So far as I can learn, the line of treat- 
ment is practically nothing, or on the whole 
that of increasing the patient's subjective 
faith. I do not think he employs hypno- 
tism, per se. The glamour of making die 
trip and waiting around for days or weeks 
arouses an attitude of hopeful expectancy. 
Before the man gained such a wide repu- 
tation he was known in his community as 
a humble "faith doctor." : 

Not having seen this man myself» I most 
rely on the descriptions of those who have 
consulted him, as well as newspaper re- 
ports, to hazard a few words about his 
personality. He is said to be anydiing but 
attractive or magnetic in appearance, and 
his features suggest nothing but medio- 
crity, or something less. It is said that no 
one hunting for a healer would be likely 
to ever accost this gentleman. He does 
not even affect any little thing in the way 
of dress to distinguish him from common 
mortals. 

This is a very simple little report of a 
case that is by no means isolated. There 
are lots of others in the game, but they 
do not all "get away with it" as this fel- 
low has and does. In the March Medical 
World I read some doctor's report of a 
case in Wisconsin very similar to this one. 
These healers have their day, and dien 
pass from the "earth earthy." Do you re- 
call Welterism? He simply tore up the 
earth in a Missouri town and had so mucb 
mail-order trade that the government could 
hardly increase its postal facilities fast 
enough to handle his voluminous business. 
His personal business was quite large, too. 
And, by the way, where is Weltmer to-day? 

I believe just as you do, that these men 
are gigantic frauds, who are for some in- 
explicable why or wherefore temporarily 
smiled upon by kindly fates. Their finish 
is never far off. At the same time, I be- 
lieve there is a psychic power possessed 
by some individuals and not by others. It 
is a talent that is as yet latent, unener- 
gized and undeveloped. In the future wc 
will work out a few things that are now 
hidden and occult, and the great achieve- 
ments of the next few decades will be tiiat 
of charting unknown and unexplored seas 
of the brain. 

Peoria, 111. 



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POSTNASAL CATARRH IN CHILDR£N. A MEANS OF EMPTYING THE BLADDER. 




Dr. Eustace Smith advises the following 
treatment in the acute stage: Paint throat 
several times daily with boroglyceride, or, 
in older children, spray with a yi grain to 
the ounce solution of tartrated antimony 
while patient inspires deeply. Later, add 
an equal amount of glyceritc of tannin to 
the boroglyceride. Where painting throat 
resisted, instil into nostril several times 
daily, while child lies back with head on 
pillow, a solution of 5 to 10 grains of 
resorcin to the ounce of saline solution, 10 
grains of boric acid to the ounce of water, 
or 15 grains of sodium bicarbonate to the 
ounce. As redness of pharynx fades, apply 
pure glycerite of tannin or a paint of 12 
grains of iodine and 15 grains of potassium 
iodide to the ounce of glycerin, with 5 drops 
of oil of cinnamon or peppermint. After 
all redness is gone, use an astringent iron 
paint of I dram of the stronger iron per- 
chloride to an ounce of glycerin. 

For anorexia: an iron tonic; stay in the 
country or at the seaside. Keep child well 
protected from cold for some time after. — 
Monthly Cyclopedia and Medical Bulletin. 



AN ANALGESIC. 



Dr. C. E. Buck, in Jour, Ther, and Diet- 
etics, says that for an all-round analgesic 
that is safe and reasonably certain in its re- 
sults, there is no combination or remedies 
better than the following: 

9 Acetanilid, 

Salol aa gr. v. 

Citrate caffein gr. ij. 

M. Fiat pulv. No. 11. 

As many of these powders as are needed 
may be given, and they can be administered 
every two or three hours with safety. 



Dr. Edward Anderson says: 'The fact 
that the bladder, when partially paralyzed 
from parturition, or any other cause, can 
always be made to empty itself perfectly by 
throwing a' large amount of very warm 
water into the bowel, thereby doing away 
with the necessity of using a catheter — a 
most important consideration, particularly 
when the patient lives at a distance from 
the doctor. After difficult and protracted 
labors I have been obliged to use the cathe- 
ter every day for weeks at a time, which 
was annoying to the patient and inconveni- 
ent to myself. Since using the above 
recommended plan I have had no trouble 
in this direction, the bowel and the blad- 
der emptying themselves at the same time.'' 
— Charlotte Med. Journal, 



A FEW POINTERS ON THE TREATMENT 
OF FLATULENCE. 



Nux vomica is one of the most usefut 
remedies for flatulence, and it may be given 
in tincture, or in pill with a quarter of a 
grain of capsicum and a couple of grains 
of compound rhubarb pill. Bismuth is of 
use in many instances, with an alkali sucb 
as bicarbonate of sodium, and columbo or 
other bitter infusion. Salicin is not used 
so much as we believe it might be, and 
given in five or ten grain doses in water 
before meals is often very helpful. Pep- 
sin seems distinctly indicated, but it is ofteo 
disappointing, and at the best it must be 
looked upon more as a palliative than any- 
thing else. Pancreatin, too, does not give 
the relief in all cases that we shotdd ex- 
pect from it. Salicylate of sodium with 
liqtior pepticus, nux vomica, and spirits of 
chloroform seems useful in a certain num- 



85 



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"ber of cases. Extract of malt given with 
or just after meals helps in those cases in 
which the digestion of starchy foods is 
obviously difficult. A few drops of dilute 
hydrochloric acid in water shortly after 
meals is often decidedly beneficial. — Burnet, 
in London Practitioner. 



GINGIVITIS IN DISEASES OF META- 
BOLISM. 

Dr. Croftan, in his thoughtful paper on 
the gingival manifestations of certain dis- 
oders of metabolism, refers particularly 
to the gingivitis that accompanies Bright's 
disease, diabetes, non-diabetic acidosis, and 
the "uric acid diathesis." In diabetic cases 
the following formulae are found useful: 

(i) For bleeding and painful gums — Tr. 
opii, 20 parts; chlorate of potash and bi- 
carbonate of soda, of each lo parts; decoc- 
tion of marsh mallow, i,ooo parts. Make a 
mouth-wash, to be used from time to time. 

(2) For excessive fetor — Beta-naphthol, 
one part; sodi, biborate, 100 parts; Aq. 
menth. pip. sodi, biborate, 100 parts; Aq. 
to 5,000 parts. Make a mouth-wash for 
frequent use. — American Medicine. 



ADENOIDS AND THEIR EFFECT ON THE 
GENERAL SYSTEM. 

Dr. G. B. Taylor, of Cameron, Texas, 
mentions as the principal results of ade- 
noids in school children, deafness, with its 
accompanying mutism in children w^ho be- 
come deaf early in life, inability on the part 
of the children to apply themselves, causing 
truancy, mischievousness, stupidity, insta- 
bility of character, derangements of diges- 
tion, headaches, lowering of the general 
health, and eye trouble. — Medical Record. 



IRIS VERSICOLOR. 



When patients come to me complaining 
of a constant pain in the small of the back, 
1 usually give them green plant iris, green 
plant bryonia, and green plant apocynum, 
and the good result is practically sure. 
The dose of the iris I use is from one-half 
to five minims, and I usually use about 15 
to 25 drops in a four-ounce mixture. In 
these small doses it should be given at 
short intervals, every hour, or two hours. 
— Dr. Wtn. M. Gregory in Therapeutic 
Record. 



FOR TROUBLESOME BLEEDING OF THE 
NOSE. 



SANE SANITATION. 



A convenient way to make the pressure 
to stop troublesome bleeding from the nose 
is pointed out by Dr. Smith, in American 
Journal of Clinical Medicine, as follows: 
Take a condom, put it over the distal end 
of a medium-sized soft-rubber catheter and 
tie it to the catheter just the length of the 
nasal fosss, so it will not swell out at either 
naris. Wet the condom and push it into 
the affected nostril and inflate by blowing 
through the catheter; then clamp the cathe- 
ter. The condom is so thin that it fits into 
-all the cavities and controls the bleeding. 
When you wish to remove it, take off the 
clamp, which lets the air out, and it can be 
withdrawn without causing irritation. This 
is easier and better than packing. 



The sane sanitation whish has converted 
the Panama zone from the plague spot of 
the New World into an ideal health resort 
is probably the most brilliant example, and 
the Spanish-American war with its wonder- 
ful lessons of heroism and unselfish scien- 
tific devotion by surgeons who laid the curb 
of prevention upon the scourge of yellow 
fever is one of the epochs of the world's 
history.— Z?r. Bogert, in "Red Back." 



Constipation, worms, or fissure of anus 
tQay cause involuntary urination. 



For Burns. — The old carron oil is an 
excellent application for most types of 
burns. The excoriated surface should first 
be cleansed with a warm boracic acid solu- 
tion. The injury may be followed up with 
this application: 

Alcohol 3j. 

Picric acid 3iij. 

Distilled water Jij. 



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'BENEFITS AND EVILS OF HEALTH 
FADS"— REPLY. 

Editor Medical Summary : 

Every advance in medicine is considered 
a fad until by general adoption it becomes 
a fact. Oliver Wendell Holmes' view of 
the infectiousness of puerperal fever was 
only a fad in the beginning. Lister's anti- 
septic method was looked upon as a fad by 
his hard-headed colleagues. The bacterial 
vaccines are still referred to as a fad by 
those who have not yet used them. 

The interesting article in March Sum- 
mary by Dr. Ernest F. Robinson deals 
very fairly with the subject, "The Benefits 
and Evils of Health Fads." One point Dr. 
Robinson makes, however, lacks clearness. 
In speaking of the open-air fad, he says: 
"As a treatment for tuberculosis there is 
no longer any doubt of its value, but as a 
fad it is becoming a serious question wheth- 
er it does more good than harm 

It is folly to place a weak consumptive in 
danger of the more fatal disease (pneu- 
monia), in the mere hope of curing the 
less fatal (consumptive)." 

From this it appears that Dr. Robinson 
harbors the fancy that pneumonia may be 
caused by breathing cold air, or by expos- 
ure to the wind, perhaps. Laboring under 
that impression, what are we to think of 
the "fad" whereby progressive therapeu- 
tists are treating their pneumonia cases on 
porches and in tents in the severest winter 
weather? The conviction that forces it- 
self on one who has had the opportunity to 
employ the open-air treatment for pneu- 
monia is that the "fad" is little less than a 
God-send for many patients who would 
otherwise be very bad risks indeed. 

This brings us back to the old sore. Is 
pneumonia an effect of weather, dampness, 



draughts, or infection? And, for that mat- 
ter, is coryza, bronchitis, et al., something 
we merely get, or something we catch? In 
fancy we "catch cold," but to alliterate, in 
fact we catch coryza — with the accent on 
the catch, 

Wm. Brady, M.D. 

1008 Lake St., Elmira, N. Y. 



DERMATITIS: THE RESULT OF THE IR- 
RITATING EFFECTS OF COLD. 

Editor Medical Summary: 

As quickly as possible the patient, being 
handled gently, is placed in a water bath, 
as hot as can be comfortably borne by the 
hand, when it is whirled about in it, and 
as soon as the cold has been abstracted the 
patient is removed and placed within warm- 
ed blankets. 

Afterward any parts that may have been 
deeply penetrated by the cold which are af- 
fected with inflammation, the application 
recommended in the annexed formula is 
freely applied, and if it does not relieve the 
inflamed parts within 24 hours, a well-made 
linseed meal poultice as hot as can be borne 
should be applied, and upon its surface and 
the surface of the part to which it is to be 
applied a thick coat of the ointment should 
also be applied. The poultice need only be 
changed three times daily, and it should not 
be continued longer than 24 or 48 hours, 
then it should be removed and the parts 
gently cleansed; and in case of the feet a 
loose-fitting pair of shoes should be worn 
for the balance of the winter. If the der- 
matitis should threaten to return a single 
application of the ointment will generally, 
in young or middle-aged people, be suffi- 
cient; in old or very much debilitated sub- 



87 



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THE MEDICAL SUMMARY 



jects, more applications and longer care 
will be required. 

In subjects of enfeebled constitutions and 
in old people, they need not be out of the 
house to be seriously affected by cold, es- 
pecially in the feet, particularly if shoes 
that are at all close-fitting are worn. 

The following prescription is another in- 
stance of the value of a judicious combina- 
tion of remedial agents, either of which if 
employed separately — the vaseline and sim- 
ple cerate excepted — would cause intense 
and injurious irritation if applied to sensi- 
tive or open surfaces, but in combination 
can be applied to such surfaces for any time 
with nothing but good resulting. The for- 
mula's usefulness may be extended gener- 
ally to suitable cases of "Dermatitis Calor- 
ica." It is claimed that the treatment is 
effective in preventing "Dermatitis Gan- 
graenosa." 

Formula for dermatitis, the result of the 
irritating effects of cold: 

5^ Acid carbolici (Calvert's 

liquid, pure) 5v. 

Tinct. iodine 5v. 

Acid tannici 3v. 

Camphor pulv 5iiss. 

Cerat. simplicis ^y. 

Vaseline Jv. 

Methyl, salicylat 5ss. 

M. ft. Ung. Sig. — Apply as often as re- 
quired, and combine with a linseed meal 
poultice as hot as can be borne, when nec- 
essary, for a short time only, for frosted 
feet, chilblains, bunions, etc. Use as often 
as necessary, if the affected area can stand 
friction, in dermatitis from frost bite, the 
more thoroughly it is massaged into the 
parts the better; in other forms no friction 
should be employed. 

In bums, sunburns, or scalds, with open 
surfaces comprising one-half of the body, 
perhaps, an injurious amount of the car- 
bolic acid and iodine might be absorbed; 
however, the author has experienced no bad 
effects whatever from its use when applied 
to extensive areas; the iodine and tannin 
apparently antagonize, together with the 
ointment bases, the toxic effect of the car- 
bolic acid, and vice versa, while the germi- 
cidal power of either are not sensibly di- 
minished, the local anesthetic actions are 
increased or retained to an effective degree. 



The entire human, and in fact any or- 
ganic or inorganic system, as well as all 
concrete, gaseous and ethereal matter, is a 
conglomeration — ^wisely blended, wastefully 
often, or insufficiently, and without a defin- 
ite object apparent, at times — of atoms, 
elements, chemical compounds, and natural 
combinations which utterly bafiSes scientific 
investigation, analysis, and synthesis; in a 
reasonable and intelligent formula, based 
upon successful experimentation, whether 
from the agricultural or the medical stand- 
point of research, the effort is made, poor 
often though it may be, to imitate nature. 
R. L. Hammond, M.D. 

Woodsboro, Md. 



ETHICS. 

Editor Medical Summary: 

There are doctors who believe in ethical 
treatment for themselves, but treat their 
medical brethren very unethically. Ther^ 
are "Ishmaelitish" doctors who have no 
more respect for the code of ethics than 
Satan has for the Decalogue. It is a love- 
ly thing to be truly ethical. However, in 
this selfish, grasping, money-getting age, it 
seems to be every man for himself, and in 
the crowded ranks of the profession it 
seems impossible to prevent one doctor 
from stealing another doctor's patients. If 
one is called to see some one sick in a fam- 
ily in which he knows another doctor is 
their family physician, and during said doc- 
tor's temporary absence, that usurping doc- 
tor would hold on like a bulldog. He will 
be sure not to say, "I will do what I can 
until your family physician comes," but will 
throw out his greedy tentacles and hold 
fast to them. 

I have always tried to be strictly ethjcal 
and fraternal in my conduct toward my 
professional brethren, and have never con- 
sented to succeed any man in a case before 
notice was given that a change was deterr 
mined upon. 

I do not boast, but I will give an exam- 
ple. One Friday morning an old gentle- 
man came into my office, saying that his 
family physician was absent from the city, 
and be wanted me to see his son who was 
sick. I said I would attend him until his 



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89 



family physician returned. The following 
Tuesday morning; while I was at the bed- 
side of the patient, the door-bell rang, and 
I heard the doctor say to mother: "Who's 
sick here?" "Walter is very sick with ty- 
phoid fever, and Dr. Field is here now." 
"Well, that's just my luck. I never leave 
home but some of my families get sick." 
I heard what he said and immediately call- 
ed to him to come into the sick-room. I 
then said: "Doctor, I took charge of this 
case with the distinct understanding that I 
was to turn it over to you on your return 
home." I told him what I was giving, and 
left him in charge of the case. He thank- 
ed me for my kindness. 

D. L. Field, M.D. 
Jeffersonville, Ind. 



TYPHOm FEVER. 



Editor Medical Summary: 

The surgeons at Camp Sam Houston, 
San Antonio, Texas, have apparently prov- 
en the efficacy of antityphoid serum as a 
preventive of enteric fever. Of several 
thousand Federal soldiers who were in- 
oculated with the serum only a remarkably 
small percentage subsequently took fever, 
and that in a light form. 

We, who occupy the country places, have 
noi yet ventured upon the serum treatment, 
but have fine success with the following 
line of treatment: Given a case of fever, 
nonintermittent, with daily exacerbations, 
being higher of evenings, brown-coated 
tongue, sordes beginning to accumulate on 
the teeth, general malaise, indisposition to 
eat — such a patient is immediately put 
under rule. He is given small but repeated 
doses of calomel and perhaps euonymin, 
foUowed in a few hours with a saline. 
After which he is put on the sulphocarbo- 
lates of sodium and calcium, five or six 
grains of each every two hours. Food is 
widiheld for a few days, but he is encour- 
aged to drink freely of water. The fever 
is controlled mainly by the use of water, 
hot and cold. Cold to the head and tepid 
sponge baths. Normal salt solution is given 
by enema regularly once a day. If there 
should be diarrhea, the zinc salt should be 
added to the sodium and calcium, forming 



the triple carbolates, while the daily enema 
should have half a dram of the zinc salt to 
substitute the chloride of sodium. Of 
course, every case will need some auxiliary 
treatment, but the above line of procedure 
comprises the prime essentials in the man- 
agement of enteric fever. It will cure and 
not be long in doing it. Convalescence is 
usually established in from ten days to two 
weeks. The only cases which run a longer 
course are such as come late under the 
physician's care. 
Three things need to be emphasized: 

1. The liberal use of water, internally, 
externally and eternally. 

2. Feed only liquid diet, fruit juices, egg 
albumen with orange juice in it, milk and 
lime water, at long intervals, followed by 
a mouth disinfectant, soups, beef juices, 
and such like. 

3. Judicious medication as above to elim- 
inate the poisonous ptomains from the sys- 
tem "tuto, cito et jucunde," 

John Freeman Neal, M.D. 
Lytle, Texas. 



MASTITIS. 



Editor Medical Summary: 

Seeing in October, 191 1, Summary, that 
"Hops stewed in lard, applied as a poultice, 
often cures gathered breasts," reminds me 
that for 35 years in a considerable practice 
I never had a case of mastitis go on to pus 
formation. When there was inflammation 
I prescribed a liniment as follows: 

9 Tr. opii, 

Tr. belladonna aa Jss. 

Spts. camphor, 

Tr. Phytolacca, 

Tr. arnica aa 5j. 

M. Sig. — Apply once a day. 
I did not trust anyone, but made the ap- 
plication myself. For 15 or 20 minutes I 
rubbed it over and over the breast until H 
or one ounce of the liniment was used. 
Thoroughness is essential, and the doctor 
who will not be will fail to cure. Then I 
made a cap of cotton, hollowing it out with 
my fingers so that it was thicker around 
the edge, and placed it over the breast, 
then applied a bandage, splitting one end 
so as to straddle the other breast and pin- 



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THE MEDICAL SUMMARY 



ncd along the back, drawing it so tight that 
the woman would say she could hardly 
breathe. The breast is usually not so ten- 
der padded as it is to disallow. Secretion 
is arrested, the blood is drawn out and the 
inflammation subsides in three or four days, 
scarcely longer. 

When I hear of a woman having a gath- 
ered breast, the thought arises, her doctor 
was a failure. 

Calcium sulphide is a good internal rem- 
edy given rapidly to saturation. The secre- 
tion can be restored by the baby pulling at 
it several times a day. 

I am retired, but every physician of fair 
ability has learned something not in the 
books. Will try to give a leaf of my ex- 
perience occasionally, if acceptable. 

G. H. Harman, M.D. 

Lancaster, Ohio. 



THE TONGUE. 



Editor Medical Summary : 

You may suspect I am going to speak of 
the pathologic state of the above-named 
member, but not so. It is of its unruly 
character that I am going to write about. 
Because there are so many loquatious doc- 
tors, I think they should be mentioned. I 
knew a doctor, now gone to his grave, who 
was so non-committal about his patients 
that even his wife was not intrusted with a 
diagnosis of any of his sick clients, and as 
for the public, he imparted no information 
to them. He evaded any answer which 
would commit him to either diagnosis or 
prognosis of a case. To the relatives of 
the sick, however, he was not so close- 
mouthed. He did not hunt up newspaper 
reporters and tell them of his sick patients, 
or magnify his own importance and skill. 
It is unprofessional. 

The physicians of our city have all 
signed a paper requesting the reporters of 
the newspapers to withhold the name of 
any physician in connection with mention 
of any case of illness. 

There are cautious, discreet, flippant, 
slandering, gossiping tongues; and some 
doctors, like other mortals, have one of 
these tongues. I have known doctors who 
talked too much, and their tongues cost 



them professional business. Some arc ad- 
dicted to talking too much in the sick room. 
They will tell of how many patients they 
have, and what ails every one of them. 
Such a habit is both indiscreet and in bad 
taste, if not offensive. A doctor should 
be dignified, but not unamiable. Attend 
strictly to the case in hand, and pleasandy 
minister to such case, but say no more than 
is necessary. Above all things, mention no 
case you are attending, unless it is abso- 
lutely required as a matter of pure civility 
to some questioner in the sick room of the 
case in hand. 

One of the most disgusting things a doc- 
tor can do is to boast of the remarkable 
cures he has made. Therefore, tonguey 
doctors are objectionable not only to the 
intelligent laity, but more so, if possible, to 
the medical fraternity. They talk so much 
that they mortify their professional breth- 
ren. D. L. Field, M.D. 

Jeffersonville, Ind. 



TYPHOID FEVER— REPLY, 

Editor Medical Summary: 

I have read with interest the article on 
typhoid fever by Dr. D, W. Reed, page 38, 
April Summary, and in a practice of thirty 
years, in a country where some part of the 
year this disease became epidemic, my ex- 
perience with the disease might be interest- 
ing, for I never lost a case of typhoid or of 
pneumonia when I was called in early in 
the beginning. 

This fever, as we all know, is due to the 
bacillus of Eberth, which can be found in 
any of the fluids of the body during the at- 
tack, and the source of the contamination 
and infection is in eatables or drinks. 

I do not care to enter any further into 
the etiology of the disease. I only intend 
to show wherein Dr. Reed and myself differ 
as to the treatment, for my experience has 
probably been more extensive than his, and 
a double graduate of medicine, yet, I admit 
we do not learn all in medical colleges, but, 
as he says, "let in the light." 

I heartily agree with the Doctor, that we 
must first clean out the alimentary canal, or, 
it might be properly called, the "sewer" of 
the body, and I also agree with him that 



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THE MEDICAL SUMMARY 



91 



there is nothing better than calomel and 

soda in small doses, followed with a saline, 
and follow the saline with a small dose of 
castor oil with three or four drops of tur- 
pentine. The oil and turpentine, however, 
are not so much for getting an action on 
the bo>vels as an antiseptic dressing on the 
gut. We here use the oil as a vehicle to 
carry the turpentine through, not caring 
whether it moves the bowels or not. This 
we repeat in 26 or 48 hours for the same 
pu^po^e, for by this treatment we neutral- 
ize tlie gasses, stimulate the entire canal, 
and as the disease advances to the stage of 
ulceration we must be more persistent in 
looking after this stage of the disease, for 
it is well known, we must keep these ulcers 
clean as possible and prevent formation of 
gases and stimulate resolution, which, as 
every one knows, turpentine is a good heart, 
intestinal, and kidney stimulant, a very 
good remedy to help clean the tongue, and 
one of our sheet anchors for hemorrhage, 
and ix\ niy estimation, nothing will take its 
p'^ce. This is all I care to say about the 
vnt^stinal treatment of the disease. Of 
course -we have other antiseptics, such as 
salol and that class of remedies; but all re- 
sort to some of them, and in uncomplicated 
attacks we will be able to turn them over to 
tne intelligent nurse, with instructions,, in 
21 days. 

.^Q'vv, as to the thermic treatment of the 
disease. This part I do not altogether 
agree >^ith Dr. Reed, more especially in the 
roethoU than in the drugs used. Hydrothe- 
™Py is one of the essentials in this dis- 
ease to keep the fever under control, not to 
keep i^ down, for it cannot be done with 
Mfety. jjj jj^y experience of 30 years I 
nave y^^ ^^ ^^^^ tj^^ to resort to the— I 
ame near saying "heroic method" — to rc- 
uce the temperature by putting my patient 
*" ^ ^old bath or the wet sheet. It is not so 

"^*^ the temperature of the water, as the 

^^apo ration of it applied to the skin. We 

, ^Pply tepid water to the hot, dry skin. 



better 



Uncovering the patient, and nothing 



^ than to take our hand, dip it into 

^^pid water, sponge the body over and 

'"» Keeping watch of the temperature, as 

P^i"ation goes on, which it does very 

^^^ly during high fever, and you will be 

^T>rised how fast you can bring it down, 

^*^ let us be careful now, for we may 



keep this up a little too long, and get the 
temperature down to uormal when our 
weak patient will have a chill before we arc 
aware of it. Let the temperature be at or 
a fraction above 100, and we can be much 
safer than to keep up our pyretic hydro- 
therapy treatment till it gets at or below a 
hundred, but if we find it below a hundred 
begin on your stimulant, to hold it up, for 
as is well known, any little shock or draught 
of air might throw our patient into a chill, 
then our object would be defeated. Of 
course, we use pyretics as well as antipy- 
retics and intestinal antiseptics, but I was 
only wanting to show Dr. Reed my method 
of the hydrotherapy treatment. Hope 
others may give their most successful treat- 
ment for this formidable disease, for we 
should be willing to give our experience 
with the most successful treatment 

In some future issue of The Summary, if 
desired, I will give my treatment of pneu- 
monia. 

From every issue of The Summary we 
get more value than the year's subscription 
price. 

Many times I have gotten more from 
that single page of "Summary Gleanings" 
than out of a journal four times the size of 
The Summary. May it live long and 
prosper. 

C. C. Cooper, M.D. 

Rolla, Mo. 



A PECULIAR SKIN TROUBLE,— QUERY. 

Editor Medical Summary: 

For the last six or eight years, or longer, 
this part of the country has a peculiar form 
of skin disease. I know of cases in New 
York, Baltimore, and other cities, so I sup- 
pose it was universal. It did not seem to 
bother much in day-time, but about 2 a. m. 
the person affected would begin to itch, 
and it would be scratch and scratch, and 
no sleep for the balance of the night; at 
first no eruption, but after scratching a 
while a pimple would show, and the person 
would scratch until the parts would become 
raw. It had no special location on which to 
start, and was contagious, especially when 
persons would sleep together. No season 
of the year did it favor. If the patient 
could resist the desire. to scratch, then no 
eruption would appear. It affected all parts 



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THE MEDICAL SUMMARY 



of body and limbs, and sometimes would 
only affect a smaller area, and again would 
attack the entire body and limbs. I never 
saw or heard of a name for it; it was not 
the ordinary itch, or as the soldiers used to 
call it, seven-year itch, and it did not affect 
persons the same way. The only symptom 
was the intolerable itching, and now mark 
the peculiarity: No eruption until after 
itching a time, and the party would scratch, 
and then a small pimple or induration would 
show, sometimes thick and sometimes very 
scattering. 

Now as to remedies : Well, what was not 
used local treatment and internal, but no 
relief imless as I said before could the pa- 
tient keep from scratching, then it would 
get well without any eruption or show on 
skin. Areenic, calomel, salicylic acid, oxide 
zinc, sulphur, iron, and nearly everything, 
even decoction of polk-root, but no relief; 
Yz to 1% sol. of carbolic acid would help 
some, but not cure. I worked and studied 
and inquired, but found no cure until at last 
I concluded to try balsam Peru, and lo, it 
acted like a charm. Would mix equal parts 
balsam Peru and liquid white vaseline and 
apply them to entire surface every second 
night until three applications are made 
and the disease was gone. In using the 
balsam I asked patients to not change under- 
clothes until after treatment was concluded, 
then to take them oflF and bum or throw 
away, as the stain of the balsam would not 
come out. 

I suppose you had some of the same dis- 
ease with you. One attack did not stop 
another if the patient came in close con- 
tact with the disease again. To show how 
slight it sometimes was, I had one small 
lump or induration on the ball of my 
thumb, and I would awake in the night 
scratching or rubbing it, and it held on to 
me for full three weeks. During the day 
nothing could be seen, but whenever I 
would scratch or rub the place then this 
pimple-bump or induration would appear. 
I cured it by keeping a solution of carbolic 
acid always with me, and whenever it would 
begin to itch I would rub the place, and 
that would stop the itching, and it eventu- 
ally got well, after using the solution of 
carbolic acid a week. 

Now, can you or any of the M. D.'s tell 
me what the trouble was? If it had a name. 



then by all means let us know. I never 
heard a name for it. Wishing you suc- 
cess, as I do all independent journals, I 
am as ever fraternally, 

G. A. Davis, M.D. 
Summit Point, W. Va. 



THE PHYSICIAITS BXXRA-PROFESSIONAL 
DUTY. 

Editor Medical Summary: 

As medical men it becomes the tendency 
of many of us at times to forget that we 
are human beings, citizens and members of 
society first, and physicians merely as a 
secondary and often more or less accidental 
consideration. It is not strange that such 
should be the case, for we spend most of 
the day and often a good part of the night 
in following our profession, either at the 
bedside or in the office or library; but if 
we would be the kind of physicians that 
count we must not forget that to do so we 
must be good all-round men, and not mere- 
ly one-sided scientists. 

Let no one think that I would belittle 
the importance of scientific study and at- 
tention to business. These are the founda- 
tion upon which the practice of medicine 
in its modern sense is based, equally with 
the training which comes from intelligent 
observation at the bedside and in the con- 
sulting room; but in order to be able to 
fully appreciate pathological humanity we 
must be thoroughly familiar with it in all 
its normal manifestations (just as we study 
anatomy and histology before we take up 
pathology), and in order to do this we 
must mix freely with our fellows in all 
their occupations and relaxations and enter 
into the spirit of their lives so faf as we 
can. 

There is no profession or calling which 
is so vital to the welfare of the community 
and the country at large as to warrant a 
man's devoting his entire time and energy 
to it, to the exclusion of his duties as a 
man, a husband and father and a fellow- 
citizen. 

We owe it to our respective communi- 
ties and to the nation to keep ourselves suf- 
ficiently well informed upon local and na- 
tional politics, not only to vote intelligently 



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93 



when occasion arises, but also to assist in 
the formation and direction of public opin- 
ion and the development of policies. Along 
certain lines, such as all sorts of health 
legislation (local ordinances and national 
laws regarding the handling of foods,, the 
disposal of wastes, the collection of vital 
statistics, etc.), the people in general look 
to the medical profession for guidance, and 
mre must not fail them for lack of accurate 
and practical knowledge of these matters. 

We owe it to our families to spend a 
certain part of every day unreservedly 
with them. We must shut our office doors 
firmly and resolutely upon the cares and 
labors of the day, and take home a smiling 
face to the wife and children. Our wives 
(let us hope) did not marry us simply to 
get a place to sleep, clothes to cover them 
and food to nourish them withal ; they mar- 
ried us to be companions to us. Our chil- 
dren have a right to look to us to share 
in their education, training and recreations, 
as well as to their mothers, and we owe it 
to them, having brought them into the 
world, to do our part in fitting them to 
live in it. Many a doctor's wife becomes 
a heart-hungry and discouraged woman, 
or learns to seek her mental and spiritual 
satisfaction elsewhere, because her hus- 
band has neglected her. Many a doctor's 
child goes wrong in one way or another 
because the father was so absorbed in look- 
ing after the physical welfare of other peo- 
ples children that he forgot to look after 
the mental and spiritual welfare of his own. 

We owe it to our patients to keep our 
bodies fit and our minds alert by taking 
sufficient physical exercise and sleep so that 
"we shall be, at all times, in a high state of 
efficiency. We owe it to ourselves to take 
a reasonable amount of mental and physi- 
cal relaxation. The club, the lodge and 
general social intercourse are almost as im- 
portant in promoting the physician's effi- 
ciency as are the medical and scientific so- 
cieties. These latter should not, of course, 
be neglected for any consideration except 
matters of life and death. No man can 
grow without mental pabulum, and he who 
feeds his intellect entirely upon text-book 
fodder will find it a dry and unsatisfying 
diet and will soon abandon it altogether 
and allow himself to fossilize. 

Very few physicians ever lay themselves 



open to the charge of direct neglect of the 
interests of their patients, but they do fre- 
quently fail directly to give them the best 
services of which they arc capable, and 
more frequently they fail to discharge their 
broader and no less urgent duties as citi- 
zens. Let every physician lay aside the 
medicine case, the test-tube and the scalpd 
for a few hours, or at least minutes, every 
day, and for a few days every year, and 
devote the time to civic and domestic du- 
ties and to recreation, and the profession 
will go forward by leaps and bounds; it 
will become a power in the various com- 
munities and in the nation ; the science aod 
art of medicine will feel an irresistaUe 
rush of new life vitalizing it, and We wiO 
take our rightful place as leaders in the 
world's thought and activities. 

G^OkQSL B. Lake, M.D. 
Fort Sheridan, 111. 



MEDICAL JOURNALS. 

Editor Medical Summary: 

Medical journals are like the whiskey in 
Texas: all are good, but some are better 
than others. Of course, the Summary is 
a "lulu." Honestly, your journal is one 
among the best. The ultra-scientific "un- 
practical" publications are of but little ac- 
count to busy practitioners. Your columns 
are not cumbered with such elaborate arti- 
cles, but afford us pabulum for ready use; 
something we may use as we grope along 
in some case, not knowing what will be the 
best treatment for the case ; when, lo, along 
comes the Summary, and very often op- 
portunely. The fogs of uncertainty and 
indecision are cleared away, and we can 
see our way out of a difficulty. You have 
practical contributors, men whose experi- 
ence comes to our assistance, and we can 
rely on it. No speculative theses. 

D. L. Field, M.D. 

Jeffersonville, Ind. 



Corns, bunions and callosities are bene- 
fited by painting with iodine. First soak 
thoroughly in hot water. 



What has become of the old-fashioned 
folks who used to drink sassafras tea in the 
spring to thin their blood? 



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THE MEDICAL SUMMARY 



THE MERITS OF APOMORPHINE HYPO- 
DERBQCALLY APPLIED. 

Editor Medical Summary : 

We all pick up a few gems as we walk 
along the pathway of life, and as a rule we 
keep them, so fearful that the other fellow 
may increase his armament of knowledge. 
A few weeks ago a man came in my office 
and complained of migratory pains front 
and back, constipation, acute distressing 
neuralgic pains in testicles, and gave me a 
line of symptoms that caused so much cere- 
bration that after my office hours I drank a 
cocktail to regain my equilibrium. He was 
given intelligent treatment, but he had add- 
ed symptoms daily, worse than any hysteri- 
cal neurotic female in the world, and he 
finally deposited himself on my nerves to 
such an extent that I made ever>' endea- 
vor to send him far away to a nervous spe- 
cialist, so that I could regain my second 
wind and have a chance to delve deep into 
pathologic cases before he would return to 
sap my waning strength. 

One day he made his appearance com- 
plaining bitterly of his rectum. The mo- 
ment that I inserted my well-oiled finger 
in the rectum he gave a shriek that old 
"Sitting Buir* in his palmy blood-thirsty 
days would have adopted him into the 
tribe, simply for his yell and the terror 
that it would inspire to his enemies. So I 
decided on a plan of treatment that acted 
so magically that a few of my medical 
friends can see that this treatment bears a 
cure on the face of it. I injected the 
fortieth of a grain of apomorphine hypo- 
dermically, and every day strengthened it 
until I had the physiological effect, or to 
a point of tolerance. After running it up 
to the thirtieth of a grain, I used it that 
strength every other day. In all I used fif- 
teen injections and effected a positive cure. 
If you push it slowly in strength, and no- 
tice they gape and have the cat-fish yawn, 
only exhibit it to a slight point of emesis, 
and you will have more satisfaction with 
this agent than any other known to me, 
and I have been in active practice forty- 
three years. What is apomorphine ? Mor- 
phine deprived of its narcotic elements by 
the aid of hydrochloric acid ; and it reverses 
the great sympathetic chain of nerves and 



takes a tuck in them. Some of you neu- 
rologists try it, and add your enthusiasm 
to mine. Have your patient lie down for 
half an hour after using it and relax. Fed 
your way with it. Spermatorrhea and all 
cases that complain of a premature dis- 
charge are relieved and satisfied and pay a 
good per cent. Have many cases that take 
the thirtieth of a grain once a week and 
laud the method and bring their friends 
that would help. 

In dysmenorrhea, one or two injections 
a day or two before the flow will carry 
them through absolutely without pain. I 
am deeply in earnest and you will give re- 
lief and effect cures to many that have long 
since abandoned all hope. And in all the 
neurosis that baffie all medical skill and are 
vampires and unwelcome visitors, change 
their minds and reverse their nerves by 
using this wonderful agent intelligently. 
The first case cited by me had paid one 
hundred dollars and taken all the nostrums 
so freely handed out by physicians, and his 
cure and the prenomenal effect of the agent 
made me determined to pass it along. Who 
will be the loser if you don't? 

A. V. Banes, M.D. 

St. Joseph, Mo. 



Aromatic spirits of ammonia is fre- 
quently a most excellent remedy in gastric 
and intestinal flatulence where a stimulant 
is needed, as in hysteria with acid eructa- 
tions and sick headache. 



Dr. Henschen in Ellingwood's Therapeu- 
tist, says : The best treatment I have found 
for impetigo contagiosa is to dissolve the 
crust in full strength peroxide of hydrogen, 
and then paint with full strength tincture 
of iodine. 



For hydrocele aspirate fluid and inject 15 
minims of a i-grain-to-an-ounce solution of 
bichloride. In about 48 hours fluid will rc- 
accumulate and on third day begins to be 
reabsorbed. 



Kill the mosquito, destroy the house fly, 
and you have disposed of yellow fever, 
malaria, and much of typhoid and septic 
infections, except when they are communi- 
cated bv direct carelessness. 



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The New Standard Formulary. By A. 
Emil Hiss, Ph.G., and Albert E. Ebert, 
Ph.M., Ph.D. 1300 pages. G. P. Engel- 
hard & Co., Publishers, Chicago, 111. 1912. 
Price, cloth, $5.00. 

While The Standard Formulary was the 
"Standard" for years, the New Standard 
being nearly three times the size of the for- 
mer with its wealth of up-to-date informa- 
tion, has become almost indispensable to the 
dispensers of to-day, it being precisely 
adapted to their needs and requirements. 
It is beyond any doubt the most valuable 
formulary for physicians and druggists 
ever published, comprising in fact all pre- 
parations official or included in the Phar- 
macopoeias, Dispensaries or Formularies of 
the world, together with a vast collection 
from other sources. The parts following 
embracing Domestic and Veterinary Reme- 
dies, Proprietary and Synthetic Remedies, 
Perfumes and Toilet Articles, Soda and 
other beverages, and Domestic Utilities. 
The book is divided into six parts, and 
whenever possible the formulas in the dif- 
ferent parts have been arranged in alpha- 
betical order. A copious index is also pro- 
vided. 

While this book is almost indispensable 
to the druggist, it is also of great value to 
the practitioner of medicine, especially to 
those dispensing their own medicines. Sim- 
ply as a reference book, it is worth many 
times its price. 

Modern Urinology. A System of Urine 
Analysis and Diagnosis. Illustrated. By 
Clifford Mitchell, A.B., M.D., Professor 
of Chemistry, Clinical Urinology and 
Renal Diseases. Hahnemann Medical Col- 
lege, Chicago, 111. 636 pages. Boericke 
& Tafel, Publishers, Philadelphia, Pa. 
1912. Price, cloth, $3.00; postage, 27cts. 

This work comprises a neatly printed, 
handsome, large volume of more than 600 



pages, and in our opinion it is one of the 
most clear, succinct, and practical works 
for the practitioner published. The book is 
divided into thirty-five chapters; at the be- 
ginning of each chapter is printed a syn- 
opsis of its contents, which is a feature 
that will be appreciated by those who may 
wish to test their knowledge, as this is un- 
doubtedly preferable to a stereotyped list 
of quiz questions. 

The author is of the opinion that the gen- 
eral practitioner does not examine urine as 
much as he would were it not for certain 
practical difficulties encountered in making 
the tests. In this work he attempts to show 
in plain language how to overcome these 
various difficulties, as well as to give the 
usual information afforded by numerous 
authorities. By the means of a series of 
"Laboratory Notes" running through the 
text, the doctor is informed of the many 
perplexities, difficulties and fallacies he is 
likely to encounter in the performance of 
the tests, and is advised how to overcome 
them. 

Diagnosis by the urine has been given a 
comparatively large amount of space, as it 
was the aim of the author to provide a 
large fund of information on this important 
branch of clinical medicine. 

This book is a valuable and most impor- 
tant addition to up-to-date literature on the 
subject of which it treats, and we know of 
none better suited for use by the general 
practitioner, and it would form a valuable 
addition to any physician's literary. It is 
right up-to-date. 



Doctor, read the advertisement pages of 
The Summary. In them you will always find 
something new in the way of elegant pharma- 
ceutical preparations of established value 
and appliances all of interest to the physi- 
cian. Our "Business Chance'* column should 
be carefully scanned. Here you will find 
bargains in needful things from time to 
time. 



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Never empty a distended bladder at one 
sitting. 

Massage of prostate is an excellent treat- 
ment for premature ejaculation. 

Salol added to gonorrheal remedies in- 
creases their efficiency remarkably. 

In every case of chronic constipation look 
for rectal ulcer, stricture, fistula or hem- 
orrhoids. 

Oil of sassafras applied full strength is 
excellent for chilblains. This is also good 
for corns. 

Agaricin, J4 grain with ten minims of 
tinct. belladonna is also very effective in 
the night sweats of phthisis. 

Picrotoxin in 1/60 to 1/30 grain doses is 
useful in the night sweats of phthisis. It 
should be given hypodermically at night. 

A great many cases of tiemorrhoids will 
be cured by forcible dilatation of the rec- 
tum under local anesthetic. 

Iodoform gauze dipped in glycerite of 
tannin and used as a tampon is a valuable 
procedure in nosebleed. 

The best and safest agents to abort a 
cold are aromatic spirits of ammonia and 
sweet spirit of niter. 

The tremors of paralysis agitans can be 
overcome by duboisine. Small doses of 
specific hyosciamus may be necessary in 
some cases. 






Never use a brittle or rough catheter. 
Never open an abscess of the prostate 
through the rectum. 

Collinsonia has proved very effective in 
the relief of hoarseness accompanyinf 
acute colds ; in fact, probably is the most 
efficient remedy we have in this conditioa. 

In flatulence, where the distention is 
chiefly in the bowels, salicylate of bismuth, 
beta naphthol, and salol, in cachet, give at 
least temporary relief. 

Chronic constipation with enlargement of 
the lower third of the rectum will cause 
pain in the back and the sensation of drag- 
ging and fullness similar to uterine dis- 
placements. 

Clamp and cautery is the best surgical 
method of removing piles and can be done 
quicker, heals quicker and is followed by 
less pain if care has been taken not to bum 
the skin. 

One writer states that in inflamed condi- 
tions of the vagina and in leucorrhea he 
uses one-half ounce of tincture of iodine 
to a quart of hot water as a douche every 
other day. This always relieves. 

In acute ptomaine poisoning from any 
cause, from poisoning from toadstools or 
mushrooms, large hypodermic doses of lo- 
belia cover almost the entire field. — Dr. EU 
Ungwood, 

In circumcision, do not employ a con- 
strictor. Slit up the foreskin and then cut 
around. Trim mucous membrane short so 
that when stitches are in it is not longer 
than the skin. 



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A Mootfaly Journal o( 

Practical Medicine. New Preparations. Etc 

R. H. ANDREWS, M.D., Editor and Pnbliiher. 2321 Park Ave.. Phtta.. Pa. 
One Dollar Per Annum In Advance. Single Copies, 10 Cents 



VoL XXXIV. 



Philadelphia. June. 1912. 



No. 4 



SUBBOBIPTION BATES: $1.00 per ytsr, in ad- 
▼snoe, to any part of the United SUtos and 
Maieo. To Foreign Oonntrles and Canada, $1.26. 

ISW 8XJB80BIPTI0NS may begin at any time dnr- 
ing tlie year. 

■OW TO BBMIT: A safe way to remit is by postal 
money order, express order, ebeck. draft, or regis- 
tered malL Onrreney sent by ordinary mail nso- 
aUy readies its destination safely, but money so 
sent mnst be at tlie risk of tbe sender. 

IB0BIPT8: The receipt of all money is immedi- 
ately aeknowledged by a postal -eard. 

CEAXQBB OF ADDBBSS: Snbecribere ehanging their 
addreesee should immediately notify ns of their 
preeent and past looatiODS. We eannot hold our* 
eelTee responsible for non-reeeipt of the Journal 
in snek eaees. nnleaa we are thna notified. 

nilOOHTZHXJAirOBS: The Summary is eontinned to 



tesponsible snbseribers nntil the pnblisher is noti- 
led by mail to diseontinueb when payment of an 
If yon do not wish 



The Smnmary eontinned for another year after 
the time psM for has expired, please notify ns to 



tha effeet. Address 



"THB MBDZOAL SUIOCABT,* 



tttl Paxk ATOn 



FhUadelphla. Pa. 



■ntered at Phila. Post Ofiee as seeond-elass matter. 



A LOCAL APPLICATION FOR PAIN. 

The following combination, sometimes 
called Sandy's local application, is very ef- 
ficient as a local remedy in rheumatism, 
myalgia, neuralgia and other painful con- 
ditions: Gum camphor, two ounces; chloral 
hydrate and oil of wintergreen, of each four 
drams; fluid extract of cannabas indica, 
one dram; alcohol sufficient to make three 
ounces. 



SICK BABIES. 

We write an editorial on this subject 
every year at this time. Our remarks are 
more in the way of reminders than any 
real elucidation on the subject. Some one 
has aptly said, "the world needs to be re- 
minded more than informed." Enlighten 
the mother, if she needs it, on these simple 
yet all-important matters: 

Less food is required in summer than in 
winter. More fluids are required in sum- 
mer than in winter. 

Teach her the value of giving the little 
one a drink frequently in warm weather. 
It is a good rule to always give water be- 
fore feeding or nursing. 

If the bowels are irritable, distilled water 
or water that has been boiled and cooled is 
to be preferred. 

If the child is artificially fed, lime water 
should be used each time in the milk, and 
milk sugar should be used as a sweetening 
agent. 

In severe gastro-intestinal troubles lav- 
aging the bowels with soapsuds is a good 
procedure. This may be best accomplished 
by attaching a soft rubber catheter to a 
common syringe. 

Too many young children are overdress- 
ed in warm weather. If not dressed suit- 
ably any treatment directed at the ailing 
child is in a measure defeated. 

Teach the mother the futility of giving 
a young child medicine aside from small 
doses of calomel and castor oil. 



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THE MEDICAL SUMMARY 



DANDRUFF, FALLING HAIR, £TC. 



TH£ DOCTOR'S OWN HEALTH. 



Here are just a few agencies used singly 
or in combination in the form of lotions, 
ointments, etc.: 



Almond oil 
Olive oil 
Castor oil 
Croton oil 
Paraffin oil 
Chrysophanic acid 
Carbolic acid 
Sulphurous acid 
Lanolin 
Glycerin 
Pilocarpin 
Liquid vaseline 

Oil 



Oi! rosemary 
Oil ergot 
Oil chamomile 
Yolk of eggs 
Borax 
Mercury 
Sulphur 
Alcohol 
Capsicum 
Cantharides 
Aqua ammonia 
Euphorbium 
mustard 



We would give more, but rather begrudge 
the space. The moral to this is quite ob- 
vious. We are using so many things that 
are rubbish. Somebody said rattlesnake oil 
was "good for" rheumatism, or that grape- 
vine ashes would cure piles, and we take it 
for granted. Our therapeutics is in a cha- 
otic state. That is one reason why we 
have drug nihilists. Let us pitch out a lot 
of our worthless remedies and instead of 
having so many drugs indicated for one 
ailment have one or two that we really 
know something about. And still let us not 
lose faith in drugs. Serumtherapy and spe- 
cific medication are a long way off. Let 
us study some of the old remedies and learn 
how to use them. 



THE HYPODERMIC. 



It is needless to state that the needles 
should always be kept clean and made ster- 
ile immediately before using. The site of 
puncture should be rubbed with alcohol. 
Avoid veins and arteries. Morphine intro- 
duced into the smallest vein carries with it 
danger. The danger of introducing air 
into the circulation is too well known to 
dwell upon. Death has on several occasions 
resulted from the fluid or air being in- 
jected into the circulation; death in such 
cases is sudden. There is, it is true, only 
a slight measure of danger ordinarily in 
giving a hypodermic, but the cautious per- 
son will try to obviate that little danger. 



The medical profession as a whole is 
actuated by broad altruistic motives. It 
works for the perpetuity of the health of 
the community individually and collective- 
ly. The majority of physicians hold them- 
selves in readiness to answer the white sig- 
nal of distress and suffering. The public 
expects physicians to hold themselves ever 
ready to respond to the beck and call of the 
ailing world. We think too much is ex- 
pected from the profession. The doctor in 
general practice — and that's where we find 
the big crowd of them — is reluctant to 
turn down night calls very often even when 
he realizes that he should do so for the 
sake of his own health and comfort; he is 
afraid he may acquire that epithet applied 
to old doctors : "He won't get out at night" 
The doctor hates to think of growing old, 
and he hates to turn down too many of 
even the worthless and unnecessary calls 
on account of the adverse criticism it may 
bring down upon him. No man sticks closer 
to his work than the doctor. Too often he 
wears himself out prematurely at the game 
and, sad to say, may not have much money 
in the end to show for his toil. 

Doctor, hearken unto the voice of the 
self-appointed seer! Take care of your 
own health, but don't be foolish about it. 
Don't worry if you are not able to respond 
to every call. Explain frankly why it is, 
and you will not lose friends by it. You 
may think yourself very popular among 
your clientele. They may tell you they 
could not possibly get along without you. 
But once you lose your efficiency, see how 
quickly matters change! The public, after 
all, values a physician on a concrete, tan- 
gible basis. His noble and loving character 
is only an incident. The moral of this 
drivel is obvious. Be a good, faithful and 
conscientious doctor, but take care of your 
own health and self-administer some of the 
good medicine you deal out so lavishly to 
others. 



All pregnant women with albuminuria 
should be put upon a milk diet; this being 
the preventative treatment par excellence 
for eclampsia. 



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99 



IS OUR EDUCATIONAL STSTBM WRONG? 

This is a day of progressive thought and 
action in politics, in science, in sociology, 
in everything. It is a day of almost uni- 
versal education, and it all takes on a util- 
tarian trend. It is also a day of varying 
and divergent theories, many of which have 
not been crystallized in the all-important 
crucible of experience. For instance, pub- 
lic school education is now receiving a bit 
of attention. One magazine is running a 
symposium on the subject of "What is the 
matter with our public schools ?" The very 
question implies, a priori, that somthing is 
wrong. 

One of America's most distinguished ed- 
ucators, Professor Boris Sidis, of Harvard 
University, among other bizarre and some- 
what iconoclastic assertions, says: "The 
present school system squanders the re- 
sources of the country and wastes the en- 
ergy and the lives of our children. The 
school system should be abolished." Dr. 
Woods Hutchinson, the voluminous writer 
for lay magazines, thinks (?) the public 
street is better than the public school, and 
that the public school system is fundamen- 
tally wrong and should be "abolished." A 
distinguished business man, O. H. Cheney, 
of New York, also goes on record as being 
opposed to modem education in the public 
schools. New York's mayor also takes a 
fall out of our school system. 

It is true that a great deal of impractical, 
useless folderol has ever been perpetrated 
upon our children, a great deal of bogus 
culture has been foisted upon them, and 
dead studies pursued for the sake of al- 
leged "mental drill." Yet we can't think 
the system all wrong. It is a democratic 
institution, the melting pot for young hu- 
manity. Even the erudite Dr. Hutchinson 
would in a personal test case prefer his 
own child in school with all its attendant 
dangers (?) rather than having him mixing 
on the street. Professor Sidis objects so 
strenuously to the public school because it 
reduces all children to a common level and 
destroys individuality. "The school," he 
states, "is not the right place for talent and 
genius." It will be remembered that Pro- 
fessor Sidis' son was qualified to enter col- 
lege before arriving at his 'teens, due to 



his unexcelled home training. Unfortu- 
nately there are few parents of the capabil- 
ity of this man. Dissenting again from the 
distinguished educator, we would assever- 
ate that it is not the purpose of education 
to specialize and bring out talent and gen- 
ius. If we all possessed these qualities un- 
fortunate indeed would the world be. 

Abuses exist in our schools; also in the 
United States Senate; also even in the 
medical profession. It would sound puerile 
to talk of "abolishing" any of these insti- 
tutions. Schools deserve more painstaking 
and intelligent regulation. Subnormal chil- 
dren, those who "can not keep up with their 
classes," deserve special grades. The med- 
ical investigation of the eyes, ears and 
throats should be more searching than is 
so often practiced. All mental and physi- 
cal defects should be taken into serious 
consideration. 

Above all, the home environment of the 
child should be looked after and the "visit- 
ing teacher" is one of the possibilities of 
the future. The bright children almost in- 
variably come from the homes of culture, 
where the parents are reading and thinking 
individuals. The schoolroom should be a 
social and educational center for both chil- 
dren and grown-ups, and there should be 
frequent meetings at which an effort is 
made to enlist the co-operation of parents 
with teachers. 



COLD IN THE HEAD. 

For rhinitis, "cold in the head" and ca- 
tarrhal affections generally, a local medica- 
ment to sniff through the nostrils is very 
grateful to the sufferer. Here is a good 
one presented by the Physicians' Drug News : 

White petrolatum Jviij. 

Menthol 3iij. 

Thymol gr. v. 

Eucalyptol 3j. 

Melt the petrolatum on a water bath and 
add the thymol and menthol, stirring until 
dissolved. When nearly cold mix the eu- 
calyptol thoroughly through the mass. The 
quantity of petrolatum may be increased if 
desired. An elegant manner of dispensing 
is in collapsible tubes. 



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THE MEDICAL SUMMARY 



DR. HKNRI BOGART. 



ABRAHAM JACOBI. 



He is not dead, and not even ill. So we 
hope. Too often we wait until a good 
man is dead before giving him his dues. 
Dr. Henri Bogart is known to us and thou- 
sands of others through his years of persis- 
tent endeavor along the line of applied 
eugenics. Through his instrumentality, if 
we mistake not, the State of Indiana adopt- 
ed on her statute books the law for the 
sterilization of the criminal, insane, de- 
generate and otherwise unfit. It came to 
be known as the "Indiana plan," and some 
half a dozen other States have since adopt- 
ed it. Dr. Bogart has talked and written 
in season and out of season for the simple 
operation of vasectomy to be legally ap- 
plied to all the unfit and undesirable class 
who are likely to procreate their own kind. 
We are glad that this idea is constantly 
gaining ground. Our charity and humani- 
tarianism has always been commendable, 
but it has in the past all been directed 
toward helping rather than preventing the 
incompetent class. Our charity ought to 
begin before its recipients are bom when 
such can be at all possible. And we are 
now making it possible. Much along this 
line will be accomplished during the next 
decade. Bogart has done his share in this 
great work. More power to him. 



DOCTOR WILEY. 



Dr. Wiley, who recently resigned from 
the chemistry end of the department of 
agriculture, has served the country long 
and well as a scientist and humanitarian. 
He gained the ill will of a portion of the 
administration and he was bitterly opposed 
by all the "interests" whose purpose it was 
to palm off on the public adulterated, con- 
taminated, short-weight goods. Dr. Wiley 
saw that his work was in a way handicap- 
ped, so he resigned to take up what he 
terms a "wider field" of endeavor. Through 
the press and the platform he means to 
continue a ceaseless warfare upon the evils 
that exist in the handling of groceries and 
medicines, as well as conducting a cam- 
paign of education designed to thwart the 
"high cost of living" by teaching food val- 
ues and how to obtain the most food for 
the least money. 



This distinguished American physician 
recently celebrated the eighty-second anni- 
versary of his birth. Though advanced in 
years, Dr. Jacobi is still young and keeps 
in close touch with scientific progress and 
with all matters of interest to the profes- 
sion. In a recent address he deplored the 
apparent passing of the family physician, 
and we here quote a few remarks in which 
he pays a tribute to that individual : "What 
I want you to continue is to admire the 
specialist, by all means; what I want you 
to learn is to revere and adore the general 
practitioner. There are a few left of the 
species called family physician. Mind what 
I say: In twenty-five years he will recover 
the place of honor which was his fifty years 
ago. It will be he who alongside and on 
account of his other work will again build 
characters and souls, which some of you 
have said is the only office left for the phy- 
sician. But I say to you that that theory 
and that demand are realized only by pre- 
paring characters and souls on the founda- 
tion of healthy bodies and sound limbs. He 
will then be a doctor that will not mount 
on a bank, as was customary for mounte- 
banks in dark centuries; but he will again 
be the general adviser, having learned from 
the laboratory men and the specialists who 
are the modem handmaids of practical 
medicine; knowing the history of his 
trusting friends and taking an interest in 
their wholeness and their wholesomeness,— 
the chum of the old people, the intimate 
of confiding girlhood, and the uncle and the 
oracle of the kids." 



Autotoxemia of a chronic character is 
often at the bottom of many tough old 
cases of headache, rheumatism and "stom- 
ach trouble." Restrict the diet and admon- 
ish the drinking of copious quantities of 
pure water. An ounce or two of castor oil 
every morning or so alternated with a 
saline sometimes works wonders in such 
cases. 



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THE PRACTICAL APPLICATION OF ELEC- 
TRICITY AS A THERAPEUTIC AGENT. 
DIFFERENT KINDS OF CURRENTS. 

By J. R. Etter, M.D. 

SDITOBIAL NOTE.— TliiB is tlM Moond of Dr. 
Etter ■ Mrlef of ihort, pr»ctlcal artidei. Bach 
artida will bt complete in iteelf; the entire 
leriet, when complete, will form a recnlar 
wotU-mtatm on '*The Practical AppUcatien of 
Btoetrlcitj as a Therapeutic Acent." Theae 
ATticlea wHl be iomethinf difTerent, that is, 
they wiU be presented in a different form from 
the general nm of matter hitherto brought ont 
on the snbject in the books. No general prac- 
tttion er can afford to miss a single number of 
THE SXJMMABT containing this Series, which 
wUl run through all the present year and prob- 
ably the next, and will give the technique of 
application minus the theory. 

We often speak of diflferent kinds of 
dcctiicity in the treatment of disease, 
such as galvanic, faradic, static, etc. This 
is a very easy and comprehensive way, one 
the practitioner will readily understand, 
especially when he grasps the intention of 
the phraseology. The best minds in the 
medical profession, as well as in the me- 
chanical field, agree that there is but one 
electricity, yet we have been able to so 
modify electricity by different mechanical 
devices as to make it behave in so many 
different ways as to almost warrant us in 
saying that there arc different kinds. We 
speak of high tension, low tension, large 
and small quantity, which simply means the 
greater or less voltage and amperage. A 
high tension current is one of great volt- 
age, and has great power to drive current 
through the body, or any other conductor 
of electricity, and the opposite is true of a 
low tension current We may have a very 
high tension current, with an almost im- 
perceptible quantity or amperage, as in the 
static machine, or a long coil faradic ; and 
we may have a low tension current with 



great quantity or amperage, as in the steady 
or unbroken galvanic. 

We often speak of the "flow" of electric- 
ity through a conductor, and, while it is 
not known that electricity "flows" at all, 
yet it is a convenient way of expressing 
our thoughts, and if the reader will just 
remember that we mean "the presence of 
electricity" in a substance, he will not get 
confused by such terms. 

If you connect up a few galvanic cells in 
series, that is, the positive pole of one to 
the negative pole of the other, then take 
the ends of the terminal wires and im- 
merse them in a mild salt solution, you will 
discover immediately that there is a differ- 
ence in the action of the two wires. The 
wire that comes from the carbon element 
will throw off a few bubbles, but the wire 
coming from the zinc element will soon be 
entirely coated with hydrogen bubbles; this 
same thing will occur if you connect wires 
to the two binding posts of a galvanic ma- 
chine, and is a point of great importance 
to know. The wire that becomes coated 
with the bubbles so freely is the negative 
pole, and of course the other is the positive, 
so that a physician can be sure at all times 
which is the positive and negative of his 
machine. A galvanometer would give the 
same information, but it is not every phy- 
sician who has one, while they all can have 
salt water. 

This is a point of practical importance 
that should be remembered, as in changing 
the cells in a machine, or changing the 
wires that come in from an electric plant, 
the binding post that formerly was positive, 
might now become the negative. In a 
purely alternating current, the phenomena 
cited above would not occur, because the 
current is reversed in rapid succession, one 
vibration being positive and the next nega- 
tive on the same wire. 



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THE MEDICAL SUMMARY 



CHANCROID: A NEW TREATMENT. 

By William F. Waugh, M.D. 

A youth in his peregrinations acquired a 
typical soft sore on the penis, near the root. 
Under the influence of various mild appli- 
cations — iodoform, peroxide, aristol, euro- 
phen, calomel Laharraque — it remained in 
the same state, except that it spread slight- 
ly. After several weeks' unavailing treat- 
ment I went back to first principles, co- 
cainized the ulcer and thoroughly applied 
fuming nitric acid. Immediate improve- 
ment followed, but about one-fourth of the 
ulcer refused to heal. Echinacea, thuja and 
other noted healing agents added to the list 
of failures. 

During the early days a bubo formed 
and threatened suppuration, but subsided 
under saturation with calcium sulphide. 
Later another appeared on the other side, 
which underwent resolution under the same 
treatment. No apparent influence was ex- 
erted over the sore by the sulphide. 

After nearly three months* treatment the 
sore was still open, and while not discharg- 
ing much, showed no disposition to heal. 
At this time Prof. Thurston, of Bennett 
Medical College, mentioned to me that he 
was securing brilliant results from the local 
application of galactenz)rme. This is the 
title under which the Abbott Alkaloidal 
Company put out their preparation of the 
Bulgarian bacilli, advocated by Metchni- 
koff as combating the colon bacilli, to which 
he attributes the advance of senility. Years 
ago I had applied bovinine to old ulcers 
and wounds indisposed to heal, with re- 
sults generally beneficial, unless the stuff 
decomposed. Later I had used nuclein so- 
lution with more decided benefit and no 
such drawback. But the suggestion that 
galactenzyme might possess valuable prop- 
erties as a local application was a new one 
to me. 

I procured some fresh tablets and direct- 
ed the patient to break one up into powder 
and apply it freely to the sore, refraining 
from the use of all other agents, as I did 
not want to mix things so as to render the 
credit uncertain. From the first applica- 
tion more benefit resulted than from any 
application previously made, except the 



nitric acid, and the sore healed completely 
in six days. 

It seems that possibly it may be worth 
while to try out galactenzyme as a local 
application. I speak only of galactenzyme, 
because this is the only preparation in tab- 
let form that was found to contain the true 
Bulgarian bacilli, in abundance and alive, 
without other and pathogenic bacteria ac- 
companying. Should this be found useful 
as a local application to wounds and ulcers 
indisposed to heal, the credit should be 
given to Prof. Thurston, from whom the 
suggestion to use galactenzyme locally 
came to me. 

No pain or discomfort attended the ap- 
plication and the patient was very decided 
in his preference for galactenzyme over 
fuming nitric acid. 

1358 Fulton St., Chicago, 111. 



WHAT IT WAS. 
By George L. Servoss, M.D, 

In the columns of the Summary for Au- 
gust, 191 1, I reported a case in which ab- * 
dominal pain was the most prominent sjrnip- 
tom. The patient was myself, and this is 
undoubtedly one of the reasons why I was 
unable to make a complete diagnosis. The 
pain was in the upper right quadrant of the 
abdomen. At the time the report was 
made there were no other symptoms indica- 
tive of any particular organic involvement 
A few months later other symptoms ap- 
peared. The pain became more pronounc- 
ed and associated therewith there w^as 
more or less nausea, more especially at the 
height of the paroxism. Later on there 
was vomiting, the vomit being extremely 
acid. With the appearance of this condi- 
tion I suspected either gastric or duodenal 
ulcer. The pain became more local in char- 
acter, remaining for the most part in the 
neighborhood of the pyloric end of the 
stomach, although there was some tender- 
ness in the upper right quadrant, suggest- 
ing gall bladder involvement. This condi- 
tion continued, becoming more pronounced 
from day to day, until, during the middle of 
February there was no time during which 
I was free from pain, and the nausea and 
vomiting, instead of occurring every w^eek 



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103 



or two, occurred several times a day. As- 
sociated with these increased symptoms 
there appeared emaciation and anemia, and 
I experienced more or less vertigo from 
time to time. There was considerable loss 
of muscular strength and even short per- 
iods of physical effort were followed by 
pronounced malaise. My stools were dark 
colored and tarry. At the time this was 
noticed I was taking considerable doses of 
bismuth, and it was to the drug effect that 
I presumed the appearance of the stools 
was due. 

During the afternoon of February* 14 I 
spat up a couple of mouthfuls of bloody 
but presumed, owing to severe vomiting, 
that I had ruptured a small blood vessel. 
This was all the blood vomited. At mid- 
night, feeling a sense of weight in the 
epigastrium, as well as one of fullness, I 
took two full doses of saline laxative, one 
hour apart. Three hours later there was 
a large, well formed, dark colored stool, 
followed by fluid stools at intervals of from 
one-half to one hour until noon of the 15th. 
In examination of the fluid stools I found 
a condition which suggested the passage 
of blood, but as there were no other symp- 
toms of hemorrhage, I gave this but pass- 
ing attention. During the afternoon, how- 
ever, after I had become decidedly weak- 
ened, and was obliged to remain in a re- 
clining position the major portion of the 
time, the bed pan was used, and at that 
time, about 3 P. M., there was a stool of 
practically pure blood passed. It was then 
realized that a series of hemorrhages were 
taking place, and I immediately took a full 
dose of atropine, followed by sufficient 
morphine to paralyze peristalsis. During 
the balance of that day and night I was 
comparatively easy, and as the drugs over- 
came the tendency to further hemorrhage, 
I became stronger. There was also almost 
• a complete cessation of the pain. During 
the day of the i6th I felt much stronger, 
although I kept in bed. That night I slept 
well lintil about i A. M., when I had a 
paroxism of pain, lasting about half an 
hour, after which I slept until 6 A. M. At 
this time I awoke with an intense desire to 
go to stool, and with the help of my wife 
went to the bathroom, only a step or two. 
The moment I seated myself upon the toilet 
I felt that I was about to faint, and so in- 



formed my wife. Some ten minutes there- 
after consciousness returned and I found 
that I had passed a large amount of prac- 
tically pure blood. With the assistance of 
a neighbor and a brother physician who 
was then called, I was led back to bed and 
surgical assistance called from Reno. 

After this last hemorrhage the anemia 
was decidedly pronounced, in fact, I . was 
practically bloodless. Dr. St. Clair arrived 
from Reno at noon, prepared to operate, 
but upon noting my condition refused any- 
thing in the way of surgical interference, 
at that time. On the 19th I was taken to 
the Sisters' Hospital, in Reno, where I was 
placed under reconstructive treatment, cal- 
cium chloride internally and iron cacody- 
late compound hypodermically being em- 
ployed until March 7th. 

At 9.30 A. M., March 8th, I wa§ operated 
upon, and it was found that there was an 
active ulcer of the duodenum immediately 
beyond the pylorus. There were adhesions 
in all directions, both from the stomach and 
duodenum, and it was with great difficulty 
that sufficient were broken up to allow of 
the posterior gastro-enterostomy, it requir- 
ing, in fact, some 30 minutes to break doww 
the posterior gastric adhesions, prior to the 
conclusion of the operation. Owing to the 
extensive adhesions radiating from the 
duodenum, it was impossible to remove the 
ulcerated area, but good drainage having 
been established through the lower opening, 
it was thought by the operators that a re- 
covery would take place through change of 
the flow from across the ulcer. 

On the 17th of March I was up and 
dressed and the following day was out-of- 
doors the major portion of the day. In 
fact, my recovery has been uneventful, with 
the exception that I was from two to four 
days ahead of the average schedule of con- 
valescence in cases of this sort. Since com- 
ing from the operating table I have not 
experienced a single recurrence of the pain 
due to the ulcer. There has been some 
hyperchlorhydria, due to the fact, undoubt- 
edly, that some of the stomach contents has 
been passing by way of the duodenum, but 
this has been easily overcome. Of course, 
as in all abdominal operative work, I have 
had more or less gas accumulation. Now, 
at the end of the fourth week after opera- 
tion, I am able to eat everything I desire. 



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THE MEDICAL SUMMARY 



In fact, my diet is much more liberal than 
at any time for the past four or five years. 
I am gaining both strength and weight 
rapidly. I sleep well, excepting when there 
is gas formation. In fact, there is a sense 
of well being generally, such as I have not 
experienced for years. 

I am again citing this case to first call 
particular attention to the fact that one 
cannot diagnose his own infirmities, as a 
rule, and also because of the fact that the 
case was first reported in the Summary as 
a "What Is It," at which time numerous 
opinions were given by the family, none 
of which were absolutely correct. It was 
simply a case of duodenal ulcer with ad- 
hesions and without involvement of other 
abdominal organs pathologically, as the 
gall bladder, appendix and other organs 
suspected of being in pathologic condition 
were found absolutely healthy. 

This case emphasizes the fact that no 
doctor should ever make an attempt to 
diagnose his own illness. Had I gone un- 
der the hands of a good diagnostician some 
four or five yearis ago it is very probable 
that I might have been given medical treat- 
ment which would have aflfected a cure of 
the ulcer, or, if operation had been required 
it would have been a much simpler matter, 
due to the fact that the pathologic condi- 
tion would not have showed as much pro- 
gression and that there would have been 
fewer adhesions. There would have been 
no anemia and little loss of general vitality 
during the earlier stages. This again em- 
phasizes the fact that we should not pro- 
crastinate, but should receive treatment 
early, when we realize that we are the vic- 
tims of anything of a pathologic character. 
For at least four years of my life I was 
practically a worthless citizen, as I was so 
decidedly below par in every way as to 
make my work decidedly mediocre. 

If you are sick, doctor, go and consult a 
brother and let him tell you what ails you, 
and let him treat you. If you treat your- 
self, in the majority of instances your 
medication will be palliative and not cura- 
tive, and you will get progressively worse. 
If you have pain you will use an antispas- 
modic, which will mask the true condition. 
In fact, you will invariably take the wrong 
remedy. Your brother will go to the bot- 



tom of the matter and discover absolutely 
what ails you and will institute the proper 
treatment, and you will recover. I am 
pleased in that I am able to report th6 ulti- 
mate outcome of this case to the readers 
of the Summary. 

Gardnerville, Nevada. 



FOR HEALTH. 
By L. D. Field, M.D. 

Those who are in easy circumstances, 
and' those who follow sedentary employ- 
ment, especially indoors, use their lungs 
but little, breathe but little pure air,, and 
thus, independently of positions, contract 
a wretchedly small chest, and lay the foun- 
dation for loss of health and strength. All 
of this can be obviated by a little attention 
to the manner of breathing. The lungs 
can be expanded to double their size or 
capacity with perfect safety, and thereby 
give a splendid chest, and give immuni^ 
to so much lung disease. The agent to ban- 
ish this dread scourge of tuberculosis is 
the pure air we should breathe. It is the 
only sure preventive required. There 
should be no obstacle external to the chest 
to impede the free inspiration of plenty of 
pure air. On arising in the morning place 
yourself in an erect posture, with your 
head thrown back and your shoulders 
brought together as near as possible, then 
inhale as much air as the lungs can pos- 
sibly hold, hold it awhile, and keep up such 
practice for some time. Do this every 
morning. I have known those who have 
inherited weak lungs to increase their lung 
capacity as much as four inches by taking 
chest exercises. Singing is a great chest 
expander. 

While every one can't pursue out-door 
employment, still sedentary persons can 
perform the morning exercise of deep 
breathing. Too many do not walk enough. 
In this age of autos, carriages and street 
cars, very few walk enough. One of the 
physicological evils of lack of bodily ex- 
ercise is constipation. It is almost the 
rule. I knew a man who was so constipat- 
ed from sedentary employment, who said 
if his bowels were to move every day he 
would suspect that he had chronic diarrhea. 



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105 



If sedentary people would live on stewed 
fruits and com bread, and make it a habit 
to go to stool at the same hour every day, 
and take time enough, they will, if they 
concentrate their minds on the business, 
finally overcome the costive habit. Don't 
take medicine, except in extreme cases. 
Don't overload the stomach. Indigestion ' 
and sluggish bowels are the prevalent evils 
of the lack of manual employment, and in- 
sufficient physical exercise. 

"Flat" dwellers and those who live in 
super-heated furnace houses should never 
neglect to let fresh air into their bed cham- 
bers during the night. If you want to 
arise in the morning refreshed, don't ex- 
clude the night air. There is nothing equal 
to old-fashioned fireplaqps or an open grate 
for health. They are ventilators them- 
selves. The old-timers who sat by the old 
andiron fireplace with the big back-log and 
hickory or beech-wood, had the robust 
health for you. Some of the finest eating 
I ever enjoyed was cooked at the log fire- 
place. 

Finally, remember to abstain from drain 
drinking. Such indulgence reduces the 
strength and produces disease. Let your 
food be coarse and plain. Drink pure water 
and plenty of it. In the morning before 
breakfast drink a cup of hot brackish water. 
Try to take your meals at regular hours. 
Don't keep late hours, but try to get eight 
hours out of twenty-four in sleep. This is 
vitally important to growing, developing, 
young people, but unfortunately they are 
the very ones who don't get the amount of 
sleep they need. 9!eep "knits up the rav- 
elled sleeve of care." 

Jeflfersonville, Ind. 



An ever-ready night light can be made 
from a bottle six inches high and one inch 
in diameter. The bottle is filled two-thirds 
full of pure olive oil that has been well 
heated about fifteen minutes, after which a 
piece of phosphorous about the size of a 
bean is dropped in and the cork securely 
applied. This, states Trained Nurse, gives 
a good light for about four months ; when- 
ever this grows dim the bottle is opened a 
little to let in oxygen. Care is necessary 
in handling the phosphorous. 



SOME SUMMER REMEDIES AND THEIR 

INDICATIONS. 

(SECOND ABTIOLE.) 

By H. Hamilton Redfield, A.B., M.D. 

The treatment of the simimer diseases of 
children resolves itself primarily around 
the question of a regulation of the hygiene 
of the case. The mother should be care- 
fully instructed as to the care of nursing 
bottles and nipples, daily and careful bath- 
mg, preferably with alkalinized water, the 
prompt changing of the napkin after each 
bowel movement, to prevent the excoria- 
tion which the stools produce. The giving 
of an abundance of pure (boiled) water. 
The thorough cleansing out of the intes- 
tinal tract, and the keeping of it as near 
sterile as it is possible. The complete stop- 
page of food, and the giving of a combina- 
♦7on of barley water and mutton broth at 
regular intervals. The use of barley water 
in these cases to me seems as much a part 
of the treatment as does proper medication, 
and any one who Will give it a thorough 
trial will be convinced of its great useful- 
ness. 

The medical treatment must be carried 
nut with the utmost care and attention to 
details. The patient should be seen daily, 
and in extreme cases several daily visits 
should be made, ever bearing in mind the 
fact that in these cases sudden changes 
occur which alter completely the aspects of 
the case, and the neglect to recognize and 
promptly combat symptoms is inviting a 
fatal termination of what might otherwise 
J) rove a successful case. 

At the onset of the case, i. e,, the first 
medication should be directed to the clean- 
ing out of the intestinal tract. This is im- 
perative, when we consider that the seat of 
the condition lies in the intestines, and is 
due to the presence of decomposing food 
substances, with an absorption of toxins. 
For this purpose calomel offers an excel- 
lent agent; give it in doses of i/io grain 
every fifteen minutes until the child has 
taken one or two grains, and then follow 
this with a mild saline laxative. If the 
calomel is vomited, as it often is, repeat the 
dose and keep it up until the entire amount 
has been taken. As soon as the action of 



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the calomel is assured begin with your in- 
testinal antisepsis. Personally I prefer the 
W-A combined sulphocarbolates, which I 
give as follows: One tablet crushed in a 
teaspoonful of the barley water every hour 
until the stools are devoid of any odor, and 
then every two hours throughout the course 
of the disease. If there occurs a fever the 
remedy of all others is aconitine, and this 
is the first of the special remedies that we 
will give consideration. 

Aconitine. — ^Aconitine is an alkaloid de- 
rived from aconitum napellus, and is ad- 
ministered in the form of the granule, the 
dose being 1/800 grain. Physiologically it 
acts as a respiratory, cardiac, sensory and 
spinal depressant, a diaphoretic, diuretic 
and antipyretic. Its action seems to be 
chiefly exerted on the peripheral ends of 
the sensory nerves, but it also possesses a 
paralyzing action on the motor nerves. The 
sensory nerves are the first, however, to 
come under the influence of this alkaloid, 
which is exerted from the periphery in- 
ward, while in the case of the motor nerves 
the action is from the center to the peri- 
phery. ^ 
Under the stimulating action of aconi- 
tine upon the cardio-inhibitory center, the 
heart is slowed and steadied, while its in- 
hibiting action on the vaso-motor center is 
productive of a lowering of arterial tension 
with a fall in blood pressure. 

By its depressing action on the respira- 
tory center the respiratory movements are 
slowed. 

Having a selective action on the mucous 
membranes it is clearly indicated in all 
conditions in which we are to combat any 
irritation of these structures, its exhibition 
in dysentery of summer diarrhea being fol- 
lowed by the most excellent results. No 
danger or apprehension need be felt for the 
safety of the patient when giving this alka- 
loid if the rule as laid down by Dr. John M. 
Shaller, of the Denver Medical College, is 
carried out, ». e., take one granule (1/800 
grain) for eacb year of the child'$ age, and 
to this add one granule; dissolve these in 
24 teaspoonfuls of water, and give a tea- 
spoonful every fifteen minutes, half hour 
or hour, as the exigencies of the case re- 
quire. As soon as the pulse becomes soft 
or the temperature approaches the normal. 



increase the interval between doses sufli- 
ciently to maintain the full physiological 
action. I have foimd that the alkaloid is 
absolutely safe when given as above,' re- 
liable and prompt in its action. In a child 
under one year of age, the dose is the same 
for a child of one year, ». e., two granules 
in 24 teaspoonfuls of water. 

In the first stages of acute bowel trouble 
it is demanded. Here the stools are fre- 
quent, watery, slimy or bloody in nature. 
As a rule these conditions are dependent 
upon sudden changes in the weather, al- 
though it works equally well in those cases 
which have for their causative factor some 
irritative condition in the intestinal tract, 
such as decomposing food or bacteria. The 
diarrhea may only be of the simple va- 
riety, with the watery or chopped spinnach 
stools, or again we may have the true chol- 
eric diarrhea of the second summer occur- 
ing in children where the stools arc slimy 
and the marked tenesmus is present. 

In addition to aconitine we have another 
remedy, which should never be forgotten 
in the care of these cases, as it occupies a 
place created by itself after the most se- 
vere trial, that gives it rank at the top of 
the list of special remedies in the summer 
diseases of children. This remedy is ipecac 
Ipecac has long been known to the medi- 
cal staff of the British Government in In- 
dia, the native physicians in India, Burma 
and Ceylon, as well as to the Japanese phy- 
sicians, as almost a specific in the treat- 
ment of the many forms of cholera occur- 
ring in those countries. With them it forms 
the dominant treatment of cholera irrespec- 
tive of the cause, either the amoebacoH or 
the bacillus of Shiga. Their only com- 
plaint being by reason of the emetic prop- 
erties of the drug, which is extremely un- 
pleasant and to be avoided if possible. 
Those of us who have given study to the 
isolation of the active principles of the 
various medical agents find no such diffi- 
culty in the use of this remedy, having in 
emetine an alkaloid that is devoid of the 
nauseating or emetic properties of the 
mother drug, and yet retaining when iso- 
lated all the agreeable qualities of ipecac, 
that make that drug the peer of all others 
in the treatment of diarrheas or dysenteries 
of whatever nature or cause. Physiologi- 



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107 



cally the action of emetine — the dose of 
which is 1/64 to 1/6 grain — is that of an 
expectorant, chologogue, diaphoretic, haem- 
ostatic and antidyscnteric. Therapeutical- 
ly it is used in cases that are characterized 
by nausea that is persistent in nature, the 
saliva is profuse, and the tongue is clean 
or slightly coated. In catarrhal conditions 
of the intestines it is the indicated remedy, 
and should be studied closely. In cases of 
diarrhea in which the stool seems to be 
composed of fermented yeast, or green, 
watery or slimy, mixed with particles of 
food or they may be bloody. 

Emetine proves its sterling worth in the 
treatment of those diseases of the second 
summer o'f childhood and which fill the 
heart of the anxious mother with anguish 
and despair. In the majority of these cases 
a history of improper diet will be elicited. 
The little patient is emaciated, face hollow 
and expressionless, the lips are blue, skin 
is cold and clammy, dark circles under the 
eyes, the fontanelles are depressed, there is 
muscular twitching during the sleep, and 
the child lies prostrate in a comatose con- 
dition; the stools are thin and watery, and 
contain quantities of slimy green material, 
while the odor is musty and stale. 

In cholera morbus, when the characteris- 
tic cutting pains which run from right to 
left across the belly, but are worse in the 
region of the umbilicus, are present, eme- 
tine has been a life-saver in many instances. 
It should be remembered in the dysen- 
tery which appears in the autumn when the 
hot days are followed by cool nights. 

Given in the dosage as above emetine 
will prove absolutely reliable in all cases 
of summer diseases of children. Under the 
influence of this alkaloid the frequency and 
nature of the stools change rapidly, the 
tenesmus disappears, the skin takes on a 
more healthy appearance, and the child 
shows a marked improvement; in some 
cases the addition of small doses of silver 
nitrate will expedite matters, but in the 
majority of patients all that is necessary 
is emetine. 

In the following papers we will consider 
the application of these diseases of such 
remedies as veratrine, digitalin, strychnine 
or briicine. dioscorein, colocynthin, gelse- 
minine, atropine, rhus toxicodendron, ber- 



berine, hamamelin, baptisin, echinacea, jug- 
landin, corydalin, colchicine and ignatia. 



THE RADICAL CURE OF PROTRUDING 
PILES. 

By S. D. Saur, M.D. 

When hemorrhoids have existed for quite 
a long time they result in some cases in 
enlarged tumors which often protrude and 
become a constant source of irritation, an- 
noyance and pain as well as a drain upon 
the vitality of the one so afflicted. * I have 
had four of these cases recently and by the 
method to be described have removed the 
tumors to the satisfaction of the patients. 

The last case I had was about a month 
ago. I shall attempt to describe the tech- 
nique employed in this case. This method, 
by the way, is safe and sure, and by care- 
fully following out the technique anyone 
can perform the operation and get results. 
One must, of course, exercise care and sec • 
that it is done under antiseptic precautions. 




Tninori Before Operation, 
everything to be clean and sterile in order 
to avoid any danger of infection. 

Mr. C. F., aged about 45, carpenter and 
farmer, had piles for more than ten years, 
and of late years they had become very 
painful and protruded a greater part of the 
time; sometimes they would bleed so the 
blood would run down his legs; he was 
pale, sallow and run-down. He had tried 
various remedies and doctors, but gradually 
grew worse. Through friends he heard 



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THE MEDICAL SUMMARY 



that I could relieve him permanently, so 
he came and consulted me. On examina- 
tion I found the whole circumference of 
the rectum surrounded by the tumors which 
were two large ones about the size of a 
large pigeon-egg. I had them photographed 
before removing and I also took a mirror, 
and letting the patient hold it, another was 
held in position back of anus so it would 
reflect the exact picture of the tumors and 
rectum in the mirror held by the patient 
himself. This is a good plan, as it satisfies 
the one who is to be operated on as to the 
condition he presents, and after he is cured 
you can show him the difference, and he 
will appreciate your efforts all the more. 
They are willing to pay from $75 to $100 
for such work to anyone prepared for such. 

I instruct the patient to have the bowels 
well cleaned out before coming to have the 
operation done, even have him use an in- 
jection if possible. The anus should be 
well cleaned and the hair shaved off; use 
antiseptic soap, then alcohol, and lastly 
paint all around with iodine. The tumors 
are taken one at a time. It is well to inject 
a solution of quinine and urea hydrochlor- 
ate, 15 grains to the ounce with five grains 
of chloretone. This gives a splendid, safe 
anesthetic solution and you have no danger 
of heart failure as in cocaine; besides, the 
anesthesia in the former lasts a great deal 
longer. 

As soon as the tumor is numbed take a 
special pile forceps clamp as shown in ac- 
companying cut. Clamp it on the tumor 




Tumor OUmped Beady for Ontting Off. 

close to base, having an assistant pull up 
the tumor so as to get a good base hold, 
but not too tense or too close to base so as 
to pull up too much of the tissue. The 
clamp is tightened and notched, then with 
a sharp knife cut off the tumor above the 
clamp blades — not below. You then have 
a clean surface and it can not bleed as the 
clamp prevents hemorrhage. Now leave 
the forceps notched and proceed to sew up 



the cut, beginning at or near the lock if 
the forceps are away from the point; this 
is, however, optional — you can begin at 
either end of cut. 

Now sew loose end, having the first 




Tumor Ramorod. 



thread double, and use No. 2 or 3 catgut. 
No. 3 is preferred. Sew in under forceps 
and over. After the first stitch cut the 




Sewing up Tumor. First Stitch in Tumor Suture. 
HftTe Double Oiatgnt Suture. 

double thread, that is, only one of the 
sutures, and this will leave only one main 
thread. Leave the suture thread that you 
cut above two inches long, and do not pull 
the first suture entirely through, leaving 
about two inches beyond the point of inser- 




Sewing Over the OUmp. Notice Looee Suture eo 
Olamp Oan Be BemoTed. 

tion to end of suture. Now sew around the 
clamp over top and down under as in cut 
five. Always leave your continuous suture 
loose over top of forceps, so you can un- 
clamp your forceps when you reach end of 
cut Leave last three or four sutures with 
double threat; this will facilitate tying at 
the finishing end, with sutures still loose in 
notch clamp is removed by pulling it down 
through bridge of sutures. You can insert 
this suture about 1/16 or 1/8 of an inch 



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109 



apart. You now make tension on your 
sutures and pull the wound or cut surfaces 




damp Bemoved — Stitches Beady to Be Drawn Tight. 

well together. Cut No. 6 will show how 
it looks when clamp is removed and stitches 
pulled taut. 




Olamp Stitchei Drawn Taut. 

Strong silk sutures can be used and re- 
moved in about ten days. If the catgut 
sutures are not absorbed in due time they 
can be removed. We let the patient stay 
in bed several days if he wishes and use the 
following suppository for the rectum: 

5^ Morphine sulph. .. . , 0.06 

Bismuth subtiit 4.00 

Pulv. opii i.oo 

Ext. belladonna 0.4 

01. eucalyptol 0.5 

Cocaine .0.J3 

Ichthyol 2.00 

01. theobrom. q.s. Ft. Suppos. No. 12. 

Sig. — Use one morning and evening. 

A pad of antiseptic dressing with band- 
age is put on. I use a solution of magnes- 
ium sulphate, two tablespoons to a pint of 
water as a local application and keep the 
gauze pad moist with it. 

Ogilvie, Minn. 



IODINE AS A THERAPEUTIC AGENT, IL- 
LUSTRATED WITH CLINICAL REPORTS. 



By C. W. Canan, B.S., M.D., Ph.D. 



That iodine was recognized as a curative 
agent long ago for various chronic condi- 
tions can be easily proven by consulting 
medical lore; that, although badly borne 
by the stomach in its free state, and pro- 
ducing various toxic phenomena on the 
general economy, it was administered for 
long periods, so confident were our fore- 
fathers of its value as a therapeutic agent. 

As years passed by the confidence of the 
profession grew stronger in its worth, but 
to overcome its disagreeable by-efifects was 
a problem not easily solved. So many and 
so pronounced were these that for a time 
it fell somewhat into disuse as an internal 
remedy. Many and varied were the agents 
used to try to overcome its toxic properties. 

Then it was that chemistry came to the 
rescue and the various salts or iodines were 
the result. These were quite an improve- 
ment, yet they were not free from the 
same objections. Chemistry, hand-in-hand 
with pharmacy, went further, and the re- 
sults achieved were still more gratifying. 
Improvement has gone on along this line 
year after year, so that we have now at 
our command preparations of iodine as 
near free from the former objections as 
pharmaceutical skill can prgduce. We can 
now prescribe iodine in almost any condi- 
tion and for an indefinite time without fear 
of producing that train of disagreeable 
toxic symptoms that was always present 
when the older products were administered. 

The field for iodine as a remedy is prob- 
ably wider than that for any known drug. 
As an internal remedy it is indicated in all 
chronic conditions where the eliminating 
process is damaged, causing an auto-intoxi- 
cation of poisonous products: where there 
is a retrograde of tissue metamorphosis; 
where the red blood cells and hemoglobin 
have been reduced below their normal stan- 
dard; where the body weight has been re- 
duced from drainage upon the system and 
where there is increased glandular growth 
or excessive tissue fluids. It holds tlie first 



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THE MEDICAL SUMMARY 



place in the treatment of chronic respira- 
tory diseases. 

Case i. — Lillian E., nine years old, con- 
tracted a severe case of pleuro-pneunionia 
with effusion. Her life was despaired of 
long after the acute stage had passed be- 
cause of her debilitated condition. There 
were extensive adhesions with a number 
of pneumonic foci. Cough dry and strength 
sapping, appetite poor and blood badly im- 
poverished. The danger signals were be- 
ing displayed on all sides, notwithstanding 
she had been taking iron, hypophosphites 
and vegetable bitter tonics. In a fit of 
desperation I decided to try arsenic and 
iodine. Soluble iodine (Burnham) was 
prescribed and alternated with arsenic in 
small doses. At the end of the first week 
I was confident that I had made a wise 
decision. By the end of the second her ap- 
petite had improved and her cough was 
much easier. Then the remedies began to 
tell on her blood supply, and she began to 
gain in flesh. By the end of the second 
month she had gained ten pounds in weight, 
and roses began to bloom in her cheeks. 
In three months she had been completely 
restored to health. 

In chronic tonsilitis we have in iodine a 
remedy to be relied upon when combined 
with local treatment. Especially is this 
true when the disease is the result of rheu- 
matism, gout, tuberculosis or syphilis. In 
cases of long standing where the tonsils are 
practically destroyed by the disease, sur- 
gery is the only rational treatment. In 
those cases where medical treatment is de- 
cided upon all diseased crypts should be 
emptied and then touched with tincture 
iodine. This should be repeated from time 
to time until the surface is healthy. To re- 
duce the hypertrophy and eliminate the 
toxic condition that produced the disease, 
the patient should be given a thorough 
course of iodine. 

Case 2. — Miss Mamie E., farmer's daugh- 
ter, age 17 years, had had two severe at- 
tacks of rheumatism, one when seven and 
the other at thirteen years of age. As far 
back as she could remember she had suf- 
fered from hypertrophied tonsils. Had 
lost school week after week with tonsilitis. 
When she came under the writer's care I 
advised removal, but it was not granted. 



She was anemic, reduced in flesh and talked 
with a nasal intonation. The tonsils were 
treated locally by emptying all diseased 
crypts and painting with iodine tincture. 
This was repeated from time to time and 
the patient made gargle with glycothymo- 
line. She was also placed upon five-drop 
doses of soluble iodine (Burnham) four 
times daily. Improvement was at first 
slow, but as the weeks passed it became 
more evident. Pink came into her lips 
and cheeks, she lost the nasal intonation, 
and began to gain in weight. Her menses 
returned (absent for over a year) and at 
the end of six months she had gained 20 
pounds. This writing is one year later and 
she remains in good health, with no symp- 
toms of rheumatism. 

The writer has found the iodine treat- 
ment (both internal and external) to pro- 
duce results superior to that of any other 
known to him in treating congested, in- 
flamed or enlarged lymphatic glands, no 
matter whether they are deep or superficial. 
The same is true of goiter when due to 
simple hypertrophy of the gland elements. 

Case 3. — Miss Amelia F., clerk, 24 years 
old, very anemic and had suffered from 
thyroid enlargement since she came into 
womanhood. Very nervous and had hys- 
terical convulsions at nearly every period, 
the flow of which was scanty and painful. 
She also suffered from palpitation and a 
choking sensation in throat. Had suffered 
from constipation for years. My diagnosis 
was a neurotic condition complicated by 
auto-toxemia. Treatment consisted in a 
thorough clean-up of the animentary canal 
with mild chloride, followed by ^saline lax- 
ative (Abbott's). Enough of the laxative 
was continued daily to insure one or two 
normal actions. Strych. sulph. 1/40 grain, 
was given t. i. d. to even up the circulation, 
as she continually suffered from cold clam- 
my hands and feet. As a constitutional 
remedy I prescribed soluble iodine (Bum- 
ham's) first in small doses, then increased 
until results were manifested. The goiter 
was anointed with a 10 per cent, iothion 
ointment twice daily at first and then once 
a day. This plan not only restored her 
health, but cured the thyroid enlargement. 

In obstinate cases of chronic malarial 
poisoning where quinine fails we have in 



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III 



iodine a remedy that should never be for- 
gotten. Especially is this true where the 
liver and spleen are enlarged as a compli- 
cation. 

Case 4. — Mrs. Lillian M., lumberman's 
wife, age 36 years, mother of three chil- 
dren (youngest eight years old), weight in 
health 140 pounds; now weighs 106; is 
very anemic with a color best represented 
by mixing a little ochre in putty. Could 
not retain her food at times, and was a 
constant sufferer from headache, which be- 
came paroxysmal at each menstrual period, 
which was very irregular. Liver and spleen 
greatly enlarged with a thickening at py- 
loric end of stomach. Face puffy under 
eyes on getting up mornings; heart action 
bad; bowels constipated; in fact, all the 
machinery had been damaged. This pa- 
tient had gone soon after marriage with 
her husband to settle in Mississippi. She 
soon contracted malaria, had taken quinine 
without measuring the. dose. When she 
found that she could not live much longer 
she returned to her native State. I was 
puzzled in deciding upon a plan of treat- 
ment that would prove beneficial. My first 
idea was to clean up. This was done with 
mild chloride and podophylin in small doses 
often repeated and followed with saline 
laxative (Abbott). The crippled kidneys 
were flushed with quantities of Bear Wal- 
low water. This far so good. Soluble iodine 
(Bumham*s) was now prescribed and al- 
ternated with strychnine sulph. 1/40 grain 
four times in 24 hours. Two weeks passed 
by and no improvement, if any, could be 
detected. I was about to make a change, 
and would have done so had I known any- 
thing better; but by the end of the third 
week the patient claimed that her head- 
ache was gone and her appetite was fast 
improving. From this time onward there 
was no doubt; pink began to show in lips 
and conjunctiva, and the skin lost its parch- 
ment look. As months passed by the liver 
and spleen decreased in size, and by the 
end of six months I do not believe that her 
husband would have recognized her, unless 
he would have had a picture in his mind 
of the girl bride he took with him to the. 
swamps of 'Mississippi fifteen years before. 
I neglected to note that I omitted the 
strychnine and gave Fowler's solution in 



its place at the end of the third week of 
treatment. 

Iodine has been a remedy much used by 
me in treating neuralgia, myalgia, lumbago 
and sciatica in their chronic form as seen 
in badly run-down and anemic patients. 

Case 5. — Mr. Jacob F., farmer, weight in . 
health 160, at beginning of treatment 132. 
Exposed himself to all kinds of weather; 
contracted grip, was in bed two weeks, 
went to work before fully recovering, and 
in less than a week was stricken with 
sciatica in its worst form. To give him a 
quick cure the materia medica was dug up 
in general; three physicians helped to do 
it, but no permanent good resulted. He 
was taken sick the second week in January, 
and when I was called upon the scene 
March was making her debut. I found the 
patient about as blue and discouraged as 
it is safe for one to get to be called ra- 
tional. Taking all that had been done, and 
the patient's run-down condition into con- 
sideration, I tried to make him see that a 
quick cure was foolishness in his case ; that 
reconstruction work must be done in every 
part of his machinery before he would be 
able to do his spring work on the farm, 
about which he was so worried. I tried to 
make him believe that I had two remedies 
that would cure him if he would be satis- 
fied to wait. I then prescribed soluble 
iodine and Fowler's solution of arsenic, to 
be alternated in small doses. This treat- 
ment was to be re-enforced by a careful 
watch over the function of stomach, bow- 
els, liver, kidneys and a thorough massage 
of affected limb daily, as the muscles bad 
atrophied badly. In a few weeks the pa- 
tient as well as myself was satisfied that 
he was on the right road to "Wellville." 
After this the rest was easy, and by the 
time. the mother bluebird was selecting a 
suitable place to rear her brood he was 
ready to go to work with a vim. 

Orkney Springs, Va. 



Brief reports of interesting cases are 
always welcomed by the Summary. 

A black eye can be much improved in 
one night by bathing with hot water for 
twenty minutes and then applying pure 
green soap and leave on over night. 



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THE MEDICAL SUMMARY 



THE HEART. 

By M. G. Price, A.M., M.D. 

There is no disease that preys upon the 
organism of man that does not speak a lan- 
guage peculiarly its own, differing in word 
and influence from other diseases, and has 
only to be correctly interpreted to unfold 
the whole story of the systemic wrong. 
Hour after hour and day after day may this 
ceaseless pleading be heard by those "who 
have ears to hear." Sometimes there is a 
confusion of voices and again the "small 
voice" is low and weak and scarcely audi- 
ble, all tending to a failure of interpreta- 
tion or to misinterpretation. Anon the 
words are loud, clear and distinct, readily 
understood and interpreted. An apprecia- 
tive ear, a keen eye and ready wit suffice to 
a correct understanding of this language of 
diseased nature. From it we learn the 
whole story ; nothing is kept back ; the book 
is unsealed; we have only to read. Some- 
times we are poor readers; our comprehen- 
sion is bad; we misinterpret; we botch the 
matter, and no wonder, for each disease 
has its own language and interpretation. 
Many diseases, many languages, much con- 
fusion, but we may arrive at some tolerable 
knowledge of what is meant by the lan- 
guage spoken. 

The heart, murmuring heart, faltering, 
wavering heart ! Why not murmur, throb, 
falter, waver? What else might be ex- 
pected of this ceaseless worker, that slave 
of the universal organism — 

Whose streams of brightening purple rush. 

Fired with a new and livelier blush. 

While all their burden of decay 

The ebbing current steals away. 

And, red with Nature's flame they start 

From the warm fountains of the heart. 

No rest that throbbing slave may ask, 
Forever quivering o'er. his task. 
While far and wide a crimson jet 
Leaps forth to fill the woven net. 
Which, in unnumbered crossing tides. 
The flood of burning life divides; 
Then, kindling each decaying part, 
Creeps back to find the throbbing heart. 

— O. W. H. 

Frequently all this is accomplished with- 



out complaint, yet more often its work is 
done under embarrassing circumstances; , 
enemies from without and from within 
harass its every pulsation. The life-tide^ 
laden with all manner of impurities, is 
poured into it until it becomes a cesspool 
of stinking filth, while it is tortured from 
without by the unwise and untoward acts 
of the host. With all this, who would won- 
der should the heart sometimes murmur? 

What are the words it uses to describe its 
troubles? They are sure, few, plain, easily 
understood. Men have caught on pretty 
well to their significance. 

My soul is filled with sadness when I lis- 
ten to the timid pleadings of a worn-out 
heart, for lately some of my best friends, 
true and tried, have "fallen asleep," be- 
cause weary hearts must needs have rest — 
but I digress. What are the words through 
which the heart speaks to our listening 
ears? Murmurs, throbbings, thrills, pulse, 
frictions, dullness^ accentuations, bruits, 
hums, dyspnea, cough, dropsy. What do 
men learn from these phenomena. Let us 
patiently listen to the story of the heart 
laboring here before us; its words are few 
and emphatic, and utter no uncertain sound 
that we may the better hear, we will use 
the stethoscope; put it down over the area 
of the pulmonary artery. What do we 
hear? A murmur. What is this murmur 
about? What is going wrong? Slip the 
instrument up over the juglar vein. There 
is a murmur here. Has it anything to do 
with the one before mentioned? I think 
so. Let us inquire further. Slip the instru- 
ment down over the apex. The same mur- 
muring complaint is there also. Has it 
anything to do with the former adventitious 
sounds? I think so. Again, what of these 
murmurs in regard to time? Listening 
closely, we hear the "lub — lub — lub" of the 
heart, and we hear the murmur also ; hence 
we know that this murmur corresponds to 
the systole of the heart. 

Again, some murmurs are irregular, but 
this is not. Some sounds are transitory; 
this is regular, permanent, abiding. In 
some cases there are moist, sibilant sobs, 
but there are none here. Now, what does 
this heart tell us by its complainings? 

1. That the murmur is in the pulmonary 
area. 

2. It is found also in the jugular vein. 



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"3 



3. It is propagated to the apex. 

4. It is systolic in time. 

5. It is continuous. 

6. It is an abiding condition. 

7. There are no rales. 

This poor, palpitating heart is talking to 
us of the condition of the circulating fluid — 
the blood. It is speaking of anemia — ^pov- 
erty of the blood — and crying loudly for 
iron, arsenic and other tonics. 

Here is another case; a very dear friend- 
Poor fellow, something has gone wrong 
with him. He is almost out of breath; his 
heart is wildly palpitating, 200 or 2000 beats 
to the minute, don't know which, uncount- 
able ; yet at the wrist the pulse is small and 
irregular, for 20 or 30 beats furious, then 
it stops, and you would think it would never 
beat again, but here it comes again with its 
rattling shivaree. This is repeated hour 
•after hour. See the heart pounding against 
the chest wall. Yes, you may plainly see 
its heavy strokes. Now listen to its mur- 
muring; the familiar 'iub'' is gone, and in 
its stead we have a murmur. We can 
trace it into the axilla and between the 
scapulae. What is this poor sick heart try- 
ing to tell us? Of the insufficiency of its 
machinery its valves are failing to do their 
work, or rather the valves of the right 
heart. More than this, there is the edema 
of the feet and legs, slowly mounting up- 
ward, and ere long the poor man will be 
drowned in his own fluid. What are we 
going to do about it? What life-line are 
we going to throw out to him to save him 
from this o'erwhelming flood? 

There are few miracles nowadays, but I 
want to tell of at least the wonderful effect 
of digipoten in this case. On February 24, 
1912, he weighed 150 pounds; on March 4, 
he weighed 120 pounds. Under the admin- 
istration of digipoten as follows was this 
result obtained : Feb. 25, he was off 5 lbs. ; 
Feb. 26, off 10 lbs. ; Fel). 27, off 6 lbs. ; Feb. 
28, off 4 lbs.; Mar. i, off 2 lbs.; Mar. 2, off 
2 lbs. ; Mar. 3, off i lb. ; total, 30 lbs. 

This treatment was preceded by calomel, 
and perhaps he took 100 grains of calomel 
during the week of treatment. The digi- 
poten was given one tablet y^ grain ever\' 
four hours. 

Mosheim, Tenn. 



ICHTHYOL INTERNALLY.-A HISTORICAL 
SKETCH. 

By a. Rose, M.D. 

From Vierordt's classical book, "Medisi- 
nisches aus der Geschichte," wc learn that 
Bismarck, during his long, active and 
eventful life, had frequently been sick. He 
died from senile gangrene on July 30, 1898, 
at the age of more than 83 years. Dry 
gangrene of part of the left foot, and heart 
failure, with oedema of the lungs, were the 
direct causes of his death. The left leg had 
given him trouble ever since the year 1857, 
at which time he had met with an accident 
while hunting. In June, 1859 — he was at 
that time ambassador in St. Petersburg — he 
had an attack, as he described in a letter 
to his sister, of rheumatic, gastric, nervous 
sickness, which was treated most irration- 
ally with cupping and mustard plasters; 
some quack had even applied a large can- 
tharide plaster on the left leg, which caused 
so much pain that Bismarck tore it off 
himself. He wrote that this fly-plaster had 
injured a vein and that he had suffered 
from this for a long time. Surgical au- 
thorities, among them Pirogow, had even 
suggested amputation, but hydrotherapy, 
especially the baths of Nauheim, restored 
him so far that he could walk again and 
ride horseback. In November of the same 
year he had a severe pneumonia, from 
which he recovered only slowly; it was 
supposed that a wandering thrombus, an 
embolus coming from crural veins, had 
been the cause. It was not until March, 
i860, that he was able to return to Berlin. 
In August, 1868, falling from his horse, he 
broke three ribs, but from this injury he 
made a good recovery, and noteworthy was 
the improvement of his general nervous 
condition. 

In regard to diet Bismarck lived in ac- 
cordance with his powerful constitution — 
he was 6 feet high, weighed 247 pounds — 
very much contrary to hygienic rules until 
the year 1883, when Dr. Sch Wenninger took 
charge of him. He was then 68 years of 
age. From alcohol and tobacco he would 
never abstain, even under the diet prescrib- 
ed by Dr. Schwenninger and followed by 
the illustrious patient. Who, says Vier- 



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THE MEDICAL SUMMARY 



ordt, could imagine Bismarck as a teetotler ? 

In addition to his habitual rheumatic 
pains, Bismarck had, in the year 1878, a 
painful attack of herpes zoster, and in the 
year 1879 he suffered from a very distress- 
ing facial neuralgia which became aggra- 
vated when he was mentally excited and 
also in damp and cool weather. His ner- 
vous condition, his nervous crises, Bis- 
marck had never denied, but spoke of them 
objectively. He suffered a great deal from 
insomnia. Morphine was given very cau- 
tiously and never continued for any great 
length of time. 

Not only from the purely human point of 
view, but also from the medical standpoint, 
it is a most remarkable fact that this man, 
suffering bodily, subject to nervous and 
psychic irritation, never lost his good 
humor and always knew at the given mo- 
ment to use the sharp weapon of his su- 
perior mind with masterly sureness. 

It must have been in the year 1885, or 
around that time, when I read in some 
journal a description of Bismarck's condi- 
tion, and how it had improved under 
Schwenninger's treatment, the most re- 
markable feature of which was the internal 
use of ichthyol. In vain have I tried to 
find this paper. I wrote to Prof. Schwen- 
ninger himself and received the following 
reply: "Villa Schwenninger (Munich), 
Jan. 25, 1912. My esteemed colleague: 1 
have been travelling; on my return to-day 
I found your letter and hasten to answer 
it, although I cannot give you satisfactory 
information, for I do not possess the arti- 
cles on ichthyol any more, and can only say 
that they have appeared some time in the 
eighties. Yours, etc." 

The only thing I have bearing on this 
matter is a letter of Prof. Schwenninger of 
September 2, 1885, addressed to and pub- 
lished at that time by the firm which fur- 
nished the ichthyol preparations; it reads: 
"I thank you very much for the prepara- 
tions which you have sent to the Prince, 
and desire to inform you that His Highness 
wishes some of the ichthyol sulpho-am- 
monium, as well as some of the pure ich- 
thyol and, finally, a mixture which, if I 
am not mistaken, is perfumed. Please send 
these preparations to Friedrichsruh direct. 
I shall within a short time write on my 



experience with ichthyol and shall refer to 
it in the yearly report for the Charite as far 
as it concerns the skin affections treated 
with ichthyol. At present it gives me plea- 
sure to inform you that His Highness has 
given his consent to tell you how extraor- 
dinarily beneficial the ichthyol preparations, 
espcially ichthyol sulpho-ammonium, have 
acted in lumbago and rheumatic affections, 
in contusions, muscular tensions and strain- 
ings, etc. Dr. E. Schwenninger." 

I wrote also to Prof. Vierordt; he re- 
plied as follows: "Highly esteemed col- 
league: Your request does not appear to 
me to be easily answered. There exists a 
'Notice on Ichthyol' by Schwenninger in 
the Charite Annalen, XI vol. (1885). It 
is a short article, only three lines, on the 
internal administration of ichthyol. The 
publication Dem Andenken Bismarck's, 
Leipzig, 1899, by Schwenninger, mentions 
nothing about ichthyol ; however, it is not 
likely that Schwenninger should have pub- 
lished something on the treatment of his 
patient while the latter was alive, especially 
not during the early period of his relations 
to him (since 1882). In the collected writ- 
ings of Schwenninger I find nothing, at 
least judging from the titles of the different 
articles, about ichthyol and Bismarck. In 
case I should find something — as you sup- 
pose it has not been in a medical journal — I 
shall at once inform you. Why could not 
Schwenninger, not having copies of the 
article, name the journal in which the same 
can be found? In general we remember 
what we have written, etc." 

And I agree with Prof. Vierordt, as- 
suming now that the paper for which I am 
looking could not have been written by 
Schwenninger himself. From memory I 
will give what I have read in some daSy 
paper or magazine at that time — about 1885 
or 1886. Bismarck, whose failing health 
had caused a great deal of distress in state 
affairs, returned after a long absence, dur- 
ing which he had had the constant atten- 
dance of Schwenninger, to the Parliament 
and caused a great and joyful sensation by 
his wonderfully improved condition; his 
weight was considerably reduced, and he 
appeared rejuvinated, refreshed in body 
and in spirit. The graphical description of 
the ichthyol treatment which I read having 



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"5 



been the main factor in producing this 
change made a great impression on me, 
and I became an enthusiastic admirer of 
this remedy, which admiration has never 
lessened in the course of the last twenty- 
six years. But of my own experience I 
shall speak later on. 

In the year 1888 appeared {Therapev- 
tische Monatshefte, Jan. 15), an article by 
Nussbaum on the internal use of ichthyol 
which I have not seen mentioned in the re- 
cent literature, but which appears to me of 
such great value that I may be permitted to 
give an extensive extract. At first, says 
Xussbaum, some patients may complain of 
unpleasant belching after they have taken 
ichthyol, but this may easily be taken into 
the bargain, the more so as it will soon 
cease. Only very few people with very 
sensitive stomachs experience a serious 
sensation of pressure and cannot continue 
taking the remedy. There are a great many 
diseases for which the internal use of ich- 
thyol as a universal remedy. All the dis- 
rheumatic gouty affections, but also in an 
army of skin diseases has it been given 
with gratifying results. In different forms 
of lupus and lepra, of eczema and herpes, 
has internal and external application been 
of good service. All capillary dilatations, 
red noses, chronic redness of the pharynx, 
hyperaemia of the larynx, even asthma com* 
plicated with eczema, gastric disturbances, 
pelvic neuralgias were treated successfully 
with it. Although these good results have 
been described and confirmed by men who 
deserve absolute credit, I do not feel justi- 
fied in judging the successful treatment 
with ichthyol from these reports, but will 
confine myself strictly to what I have per- 
sonally experienced. It is indeed a misfor- 
tune for ichthyol that it has been recom- 
mended as a remedy in so many diseases. 
It appears as if we were hunting for a 
universal remedy, and I am firmly con- 
vinced that many a practitioner has for 
this reason hesitated to use it and give it a 
fair trial. But if one carefully analyses all 
*hc facts the matter will appear in a differ- 
ent light. We do not need to think of ich- 
thyol has been recommended. Not only in 
cases and affections in which ichthyol is 
useful are characterized by hyperaemia and 
dilatation of the capillaries, and I have ob- 



served that whenever ichthyol is applied in 
such cases of dilatation it causes constric- 
tion. 

All asthmatic evils, all gastric disturban- 
ces, all pelvic neuralgias, and sciatica, pro- 
vided they are influenced by anomalies of 
circulation combined with dilatation of 
blood vessels, are attainable by ichthyol. 
This explains why ichthyol in some affec- 
tions with similar symptoms, but due to dif- 
ferent causes, are not benefited by ichthyol. 
Nussbaum enumerates his experience espcc- 
pecially in cases of neuralgias and pains in 
bones, joints and muscles, in which there 
was great interference with motion, which 
for months had been unsuccessfully treated 
with different remedies, but in which inter- 
nal administration of ichthyol had secured 
relief, to the surprise of the patients, within 
a few weeks or even in a few days. There 
were cases with distinctly gouty inflamma- 
tion in which exudation had reduced mo- 
bility, every motion of the joint produced 
audible crackling noises, and in which the 
internal use of ichthyol relieved the pain 
and restored mobility. The suspicion of 
being considered a universal remedy might 
be suggested by the fact that there exist so 
many different ailments in which capillaries 
are dilated and in which a surplus of mat- 
ter is accumulated, giving indication for the 
use of ichthyol with its wonderful action, 
to regulate such conditions. It appears al- 
most comical, says Nussbaum, when pus- 
tules, red noses, tumor albus and sciatica 
are placed alongside one another on the 
therapeutic list, and still it is the truth that 
ichthyol acts in all these cases by its vaso- 
constricting properties. It will prove of 
service to the hot fluctuating knee, whether 
the cause is phymatiasis or simple arthritis 
it acts in both instances beneficially on the 
anomalous dilatation of the vessels and on 
the exosmotic products. Nussbaum gave 
ichthyol in pill form of ij4 grains, five to 
twelve pills twice a day. Experimenti causa 
he took himself 50 pills daily without notic- 
ing any ill effect. 

Ever since the year 1885, after I had 
learned the details of Bismarck's case, I 
employed ichthyol extensively. One of my 
first cases was that of a lady who for many 
years had been suffering in a ;nost distress- 
ing way from urticaria, I ordered ichthyol 



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with the understanding that it should be 
taken for at least a year without interrup- 
tion. In the course of five or six months 
she was completely and permanently cured. 
Before I resorted to abdominal strapping 
for enteroptosia I relied entirely on ich- 
thyol taken internally for a great length of 
time, and the result was gratifying. Pa- 
tients were soon complimented for their 
improved complexion and for having gained 
in weight. I could speak of it to lady pa- 
tients as a beautifier. With the increase in 
weight the ptosis would be overcome. 

I do not know if Nussbaum's theory is 
correct that ichthyol acts only by constrict- 
ing the dilated capillaries, I considered it as 
a means to regulate the imperfect metabol- 
ism. And I believe this is now the generally 
adopted view, and if it is given in case of 
phthisis or chronic infections diseases of 
any description it acts by raising the power 
of resistance in the system. All patients 
who had taken ichthyol for some length of 
time — as a rule, for one or one and a half 
years — ^would speak with enthusiasm of its 
g^ood effect on their health in general. I 
g^ive it in all cases of enteroptosia in which 
I apply the abdominal plaster belt. 

A number of years ago a lady suffering 
from extreme enteroptosia, especially float- 
ing kidney, was sent to me from a univer- 
sity hospital to give my method a trial be- 
fore nephropexy should be resorted to. 
She had been in the hospital for a long 
time, had had the best care and the most 
skilful attendance, but her condition of 
high-graded neurasthenia was most pitiful. 
She was about 30 years of age and weighed 
92 pounds when she came to me. I applied 
the plaster belt and gave ichthyol. In the 
course of time she gained about 35 pounds 
and correspondingly her general health im- 
proved. She is this long time a picture of 
health. 

But now we come to a most extraordi- 
nary phase of the history of the internal 
use of ichthyol, and it is on account of this 
phase that I am writing this paper. When 
the colleagues of that university hospital 
who had recommended the patient with 
enteroptosia to me learned of the ordination 
of ichthyol they were not aware that it 
ever was given internally. This was about 
five years Jtgo. But still in the year 1910 



one of the Berlin coryphsus of gastric 
diseases wrote on flatulence and indicanuria 
in connection with it, mentioning that 
ichthyol had been thought of in such cases, 
but that he had no experience with it 

A generally well-known fact is that there 
existed, especially among the professors of 
the university of Berlin, a most pronounced 
animosity toward Schwenninger, and this 
may have been the reason why his original 
method of treatment was passed over in 
silence. The tone in which the Berlin cory- 
phaea spoke of ichthyol in the year 19 10 of 
a remedy on which there exists now a for- 
midable literature, confirms this assump- 
tion. Anxious to learn why the American 
colleagues had no knowledge of the internal 
use of ichthyol I examined some of the 
popular books on materia medica, and I 
found in the two last editions of one of 
them the following remark : "It is doubtful 
if it is of any practical value when given 
internally." In another very popular Amcr- 
can work on therapeutics and materia med- 
ica, published in the year 1909, it reads: 
"Ichthyol was introduced twenty years ago 
(1890) by Unna." 

Certa amittimus, dum incerta petimus!-' 
(Plautus.) 

173 Lexington Ave., New York City. 



HOME ACCESSORIES IN OBSTETKIC 
PRACTICE. 

The obstetrician is often asked by the 
expectant mother, especially if she be 
young and inexperienced, as to the acces- 
sories, remedies and agents that may be 
useful or necessary during her accouche- 
ment. Here is a list of a few things which 
the doctor may hand the mother some days 
or weeks previous to her confinement. It 
is intended by no means as a perfect reper- 
toire, but is only suggestive: 
Olive oil, I lb. Boric acid, i lb. 
Gauze, 5 yds. Absorbent cotton, i lb. 

Lysol Binders, breast&abdomen 

Alcohol, 8 oz. Safety pins, all sizes 

Basins Carbolized vaseline, i lb. 

Towels Powder, talcum or rice 

Brandy Rubber sheet or oil cloth 

Castile soap Fountain syringe 

Cotton diapers Binders for babe 



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ol PlmGli€alMedkiDe,<lrawBh«aitbe bertaad 
out from tbe dwf . medKal gnins «l ml ▼•!■•. 



ELECTRO-THERAPEUTIC AWAKENING. 

Dr. Edward C. Titus states : That electro- 
therapeutic methods are becoming more 
thoroughly appreciated by the profession in 
the treatment of functional derangements 
and diseased conditions is forcefully illus- 
trated in a paper read recently by a noted 
specialist before the G. U. Section of the 
New York Academy of Medicine on the 
use of high-potential electrical currents in 
genito-urinary surgery. The writer cited 
24 cases coming under his experience dur- 
ing the past eighteen months, showing 
quicker response and far better results than 
obtained by some of the older methods. 
The cases included epididymitis, both gon- 
orrheal and tuberculous — vesiculitis, acute 
and sub-acute prostatitis, which were treat- 
ed by the high-potential, high-frequency 
vacuiun tube application — ^and some cases 
of impotentia, due to irritable prostate and 
deep urethral disease by means of indirect 
d'Arsonvalization, with partially insulated 
copper sound in urethra. 



VERTIGO. 



Vertigo usually originates in irritation of 
the brain and cord; those subject to attacks 
are sensitive to drugs, which, in excessive 
doses, produce this state. We should there- 
fore give such patients only small doses (if 
any) of arsenic, columbo, gold, guaiac, iron, 
quinine, salicylates, strychnine, turpentine, 
acctanilid, aconite, belladonna, chloral, co- 
cain, ergot, ether, exalgin, gelsemium, ni- 
troglycerin, musk, opiates, phcnacetin, phy- 
sostigma, valerian, veratrum, aloes, am- 
monium chloride, copaiba, ipecac, jobor- 
andi, male fern, potassium chlorate, san- 
tonin or tartar emetic. — Am, Practitioner. 



POPULAR FORMULAE FOR HYPODERMIC 
INJECTION IN HEMORRHOIDS. 

Hoyt's Formula — 1^ Acid carbolic, ir^lxxx; 
Ext. hamamelis (Pond's), Aquae dest., aa 
Jvj. M. Sig. — Inject a few drops into pile 
sack. 

Ryan's Formula — ^ Oleum olivae, ^ij; 
oleum ergottae, 5Ji oleum cocain, (5 per 
cent.), 3ij; acid carbolic, ^iss. Add the in- 
gredients in the order named, observing to- 
dissolve the acid by setting the container 
into a vessel of very warm water before 
adding the others. Inject from three ta 
ten drops. 

Terry's Formula — ^ Rub a dram of sali- 
cylic acid into a dram and a half of gly- 
cerin, and incorporate two drams of pure 
carbolic acid; to this add a dram of borax 
and a dram and a half of glycerin, and al- 
low to stand until clear. A small hemor- 
rhoid requires three to five drops, and a 
larger one five to eight drops. 

Patterson's Formula — 1^ One part car- 
bolic acid and two parts each water and 
glycerin. Inject about twenty drops into- 
the center of the tumor. 



VEGETABLES AND TYPHOID. 

Recent experiments have shown conclu- 
sively that a plant growing up through pol- 
luted soil will take up on its leaves germs 
from the soil, and that an occasional rain 
does not necessarily wash away the germs. 
Lettuce may thus be a means of transmit- 
ting typhoid fever from polluted soil, even 
if the pollution occurred before the seed 
sprouted. It is well to remember the fact 
that raw vegetables, unless one knows 
where and how they have been grown, do 
not carry a clean bill of health. — Life & 
Health, 



117 



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CLINICAL vs. LABORATORY REPORTS. 



SODIUM SUCCINATE. 



It is the proud contention of the profes- 
sion that medicine is quickly evolving from 
the empirical state into the scientific. Fifty 
years ago we used remedies because the 
results obtained at the bedside showed the 
great benefit we could derive from them. 
Since the beginning of the last century, 
however, thinking physicians have rightly 
evolved the question, Why does a certain 
remedy affect a certain disease? There 
must be some relation between this remedy 
and the disease. With the evolution of 
chemistry and pharmacology, medicine 
made use of these sciences, and drugs were 
submitted to analysis to ascertain their 
value. As long as bedside experience and 
laboratory experience went hand-in-hand, 
the results obtained were beneficial, but 
when in the .eighties of the last century a 
nihilistic tendency swept over medicine, the 
experimenter became of more importance 
than the clinician, and the purist in medi- 
cine asserted that only drugs whose phar- 
macological constitution showed medicinal 
value should be used. Thus we forgot that 
neither chemistry nor pharmacology is an 
absolute science; they both progress and 
new methods are invented daily. It is high 
time that the clinician came to his own 
again, and the value of bedside experience 
should go before laboratory researches. A 
physician can exist only if he has results 
in curing his patients, and no physician will 
prescribe a remedy from which he does not 
gain such results. The reports in refer- 
ence to drugs coming from reputable hos- 
pitals should absolutely be taken as the 
standard. If such reports can be seconded 
by laboratory experiments, the value of the 
drug has been absolutely proved, but if the 
chemical and pharmacological analyses do 
not corroborate the reports from bedside 
experience, we should prefer the latter to 
the former. — ^A^. Y, Medical Journal. 



Dr. Stark, from an experience with sod- 
ium salicylate in mumps, strongly recom- 
mends five grains each of sodium salicylate 
and sodium bicarbonate, given in sugar and 
water sufficient to make one-half ounce 
every two to four hours. 



The Council of Pharmacy and Chemistry 
has admitted sodium succinate to the honors 
of the officinum. Henceforth it is to be re- 
ceived as a fully accredited member, its 
union card in its pocket, entitled to all priv- 
ileges and immunities of the guild. Official- 
ly it ranks as "a saline cathartic" — for 
which no living man ever used it — and has 
a claim (on not very good evidence) to an 
antiseptic action in the biliary tract; while 
"some (thousands of) clinicians claim that 
it is useful in combating infections of the 
gall-bladder and biliary passages." 

That's a good deal for the Council. We 
always feel relieved when their pronuncia- 
mentoes are not radically wrong; and a 
slighting, grudging half-truth like this is 
above the average expectation. When a 
drug can not be tested on a healthy dog, 
and nothing is available but "clinical obser- 
vation," these gentlemen are helpless.— 
Clinical Medicine. 



The sounds of the foetal heart are best 
heard at the end of the fourth or beginning 
of the fifth month at a point midway be- 
tween the umbilicus and the left (or less 
frequently the right) anterior superior 
spine of the ilium. 



6ELSEMIUM IN PARALYSIS A6ITANS. 

During my study of this drug, says Dr. 
Pitts Edwin Hawes, I have found an ab- 
normal condition which yielded to the gel- 
semium that is rarely mentioned by those 
writing upon this agent — paralysis agitans. 
Cases were reported which had been cured 
by this remedy alone if persisted in for a 
sufficient length of time. Doses of ten 
drops were given in water before each 
meal. Th[s 'vas continued for several 
weeks before zuy improvement was no- 
ticed. Many forms of medication had been 
used before trying the gelsemium, but they 
had all proved ineffectual. 

Accepting the theory that gelsemium acts 
upon the motor nerves, relieving irritation 
caused by them upon muscular tissue, we 
can understand how this pitiable condition 
might be entirely cured by the continued 
administration of gelsemium. 



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SINGULTUS. 



"A DOCTOR'S STORY."-COMMENT. 



Editor Medical Summary: 

I was called to see a middle-aged man 
who had been suffering several days with 
almost incessant hiccoughs. He looked 
thoroughly exhausted. Had tried several 
remedies, but only got temporary relief. I 
saw that he was very nervous, and could 
not see that it was from gastro-intestinal 
disease. Up to the beginning of the hic- 
coughs he had been comparatively well. 
His occupation was that of a ship carpen- 
ter, and he had been in the habit of eating 
his breakfast and noon-day lunch very hur- 
riedly. I also satisfied myself that it was 
not symptomatic of any disease, but must 
have resulted from fermentative conditions 
in the stomach. My treatment was one 
drop of carbolic acid, ten drops of chloro- 
form, and fiwt of essence of peppermint, in 
a little water, every two or three hours 
until relieved. The next day it had disap- 
peared, and never returned. 

Another case, just dismissed, was that of 
a farmer seventy- fouf years old, who had 
been troubled with eructations, pain and 
hiccoughs an hour after meals. He com- 
plained of choking sensations when his 
stomach was empty, but immediately suc- 
ceeding a meal he felt better. I put him 
on chloroform lo drops, carbolic acid two 
drops in mint water, and he has been get- 
ting along fine, after having suffered for 
weeks. The doctor who attended him had 
the contents of his stomach analyzed and 
told him his trouble was purely indigestion, 
giving him bismuth, nux vomica, etc., but 
no good came of it. The carbolic acid and 
chloroform acted like magic. 



Jcffersonville, Ind. 



D. L. Field, M.D. 



Editor Medical Summary: 

I was pleased to see in your March issue, 
under the caption of "A Doctor's Story," a 
really good thing to show, how much the 
average citizen thinks of the doctor in at- 
tendance. When the pain is intense or 
where the life hangs by a thread, then the 
doctor appears as a demigod; he is looked 
upon as an oracle and a savior. 

Upon the recovery of the patient he is 
still among the gods, but the lesser ones, 
and this continues until his bill is received. 
But should he want his money, and then he 
goes lower and lower, until his satanic 
majesty is a prince alongside of the god 
of a few months before. 

Now, take the case in point. The rela- 
tives knew the cause of death of this pa- 
tient. This being the case it shows that in 
this case at least, the relatives would pre- 
fer to blast the reputation of a worthy doc- 
tor, to ruin at one sweep the business that 
it had taken years to build, rather than ac- 
knowledge that Mr. X. took an overdose of 
alcohol ; that he died of alcoholism ; because 
some irresponsible chucklehead might point 
to his niece or grandchild and say her uncle 
or grandfather died of whiskey, or a drunk- 
ard. 

We have in most of the States a law 
under which the doctor, if he so chooses, 
can clear up the diagnosis or cause of 
death easily and readily. The coroner or 
medical examiner can help, and the doctor 
who lets a case go to the undertaker (if 
there is a chance of his diagnosis or treat- 
ment being called into question) makes a 
great mistake, and is personally at fault, 
and should accept the blame and take his 
own medicine. Nobody cares for the repu- 



119 



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THE MEDICAL SUMMARY 



tation of the doctor except his immediate 
family and circle of friends, and his cash 
receipts show how many friends he has. 

I had been treating a case of Bright's 
disease for about six months. The patient 
had several attacks, and I told his family 
that his life was hanging by a throad, that 
he might live six days or six months, that 
it would depend upon them and himself. 
His heart was bad and there was no chance 
for him. He had been confined to the house 
at times with some of these attacks. No 
swelling of the legs to speak of, and as they 
said, nothing the matter except a little 
"malaria." I offered them consultation, and 
it was not accepted. He was confined to 
the bed for a week with one of these 
"spells." I saw him about 11.30 A. M. and 
told the folks that he was feeling better, 
but to look out for him and keep him in 
bed. About i P. M. I received a hurry call 
that Mr. X. was worse. Upon entering the 
room he lay on the floor dead, wholly dress- 
ed and, a letter he had been writing lay on 
the table. 

There was immediately a lot of talk, etc., 
questions asked and opinions expressed, 
some sensible, but the most of them mere 
"hot air." "Yes, I had told them it would 
be sudden, but they did not believe it" ; "he 
was getting so much better" and "he must 
have got an overdose of something." The 
coroner got this case quick. Fatty kidneys ; 
vegetations in and around the valves of 
heart and an antimortem clot. This settled 
the cause of death, and it also settled all 
the talk; and if more of the doctors would 
take the "bull by the horns" there would be 
less talk of doctors' mistakes and less blast- 
ed reputations, and always remember that 
all hyenas are not covered with hair, and 
that all adorers are not friends, and they 
keep up the friendship ( ?) for what little 
personal gain it is possible for them to re- 
ceive. F. J. Davis, M.D. 

1962 San Pablo Ave., Oakland, Cal. 



Common white lead, the same as used by 
painters, is said to be a very satisfactory 
remedy for piles when applied locally. 

Application of formaldehyde and glycer- 
in, equal parts, is stated to be an excellent 
remedy for fistula. 



SENSE OF TOUCH IN DIAGNOSIS AND AS 

AN INDICATION TO DIRECT 

TREATMENT. 

Editor Medical Summary: 

The sense of touch is one of the most 
valuable and, at the same time, neglected 
aids in refined diagnosis. The -presence or 
absence of atrophy often decides the diag- 
nosis and course, the prognosis and treat- 
ment. In infantile spinal paralysis the loss 
of power is often widespread at first. It 
is important to know what degree of resid- 
ual permanent paralysis will be present 
This is indicated by atrophy. The sense of 
touch, if educated by training, will settle 
this problem more certainly than the eye. 

In appendicitis, palpitation is the first and 
by all means the most important procedure 
upon which to depend. The history of sub- 
jective symptoms in any g^ven case may 
lead one toward other diagnosis; but pal- 
pation will give the keystone among the 
facts elicited in getting the history of the 
case. The degree of skill necessary for ac- 
curate palpation of the appendicial region 
is acquired so readily. One is soon enabled 
to palpate a normal appendix. 

In diseases of women the sense of touch 
is most important in diagnosis. The finger 
tells the condition of the uterus, vagina, 
bladder, rectum — indeed all these parts, 
and does it so well that it becomes our most 
reliable guide and treatment. 

The obstetrician relies wholly upon the 
sense of touch, not only in determining the 
presentation and position of the child, but 
the condition of every part engaged in the 
process. His touch tells him the condition 
of the depending portion of the uterus as 
an outlet, and also the condition of the 
organ as regards the power of expulsion. 
It determines the condition of the vagina 
as a parturient canal, and becomes so sen- 
sitive that it recognizes intuitively changes 
of conditions that will render the labor 
painful, protracted or difficult. If the parts 
show constriction with want of secretion, 
(pinched expresses the condition of the 
parts) all of the lower segments of the 
uterus, vagina and perineal tissues. We 
know we will have a protracted and diffi- 
cult labor. Indication — relaxation and rest 
may be secured by H. M. C. (Abbott) hy- 



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121 



podermically, letting the patient rest and 
sleep for three or four hours. Then often 
the parts will be relaxed and pains will 
come on with renewed forces, terminating 
labor frequently, speedily and safely. 

If in examinating we find the vagina re- 
laxed, cervix dilated, parts moist, uterus 
contracting feebly, tissues loose and flacid, 
presentation normal, been in labor some 
time and becoming despondent, indicating 
the want of tone and power in the uterus, 
fluid extract ergot is the remedy. Give one 
dram and repeating in thirty minutes will 
act like a charm, giving the best results. 

If during a tedious labor we find the tis- 
sues thick and doughy, with the os and ad- 
jacent parts rigid — Indication, relaxation 
and stimulation. A good preparation of 
lobelia, 20 to 30 minims, hy podermically, 
repeated in one hour, if needed, will 
promptly modify the patient's suffering and 
terminate labor speedily. 

Wm. M. Lyday, M.D. 

Penrose, N. C. 



imagine, but because it produces the low- 
ered vitality that gives the bacteria the 
chance they need, 

Ernest F. Robinson, M.D. 
Auburndale, Mass. 



HEALTH FADS.— REPLY. 

Editor Medical Summary: 

I note in the May issue the reply by Dr. 
Brady to a part of my article on Health 
Fads. This seems to be due merely to a 
misunderstanding of terms. I should not 
consider the intelligent, scientific use of 
any form of treatment, by physicians, as a 
fad. It is the unintelligent use of them by 
the laity that does the most harm. I do not 
suppose that Dr. Brady would deny the 
fact that such unintelligent use of the open- 
air treatment might result in pneumonia. 
It is perfectly true that pneumonia is a 
germ disease but unintelligent open-air 
treatment can do more to prepare the sys- 
tem for the invasion of these germs, and 
others, than almost anything else. 

We should not forget that bacteria are 
harmless if the system is strong enough to 
conquer them. If the open-air treatment is 
intelligently used and improves the strength 
of the patient it lessens the danger of pneu- 
monia. If, on the other hand, as is often 
the case, it is so used as to weaken the pa- 
tient, it makes pneumonia almost a cer- 
tainty; not because cold produces the pneu- 
monia, as the doctor seems to think that I 



CEREBRO-SPINAL MENINGITIS. 

Editor Medical Summary: 

In your April number you ask if your 
readers can give a treatment for menin- 
gitis? This spring there has been an un- 
usual prevalence of epidemic meningitis in 
Louisville, across the river from us, but in 
our city of 16000 souls we have been ex- 
empt from it. It certainly is not contag- 
ious, as large numbers of our people go 
back and forth to the city by ferry, inter- 
urban cars, and by steam road. Hundreds 
of citizens find daily employment there, and 
are, of course, subjected to exposure. If it 
were contagious they would very probably 
contract the disease. That it is infectious 
there is no doubt, but it prevails in unsani- 
tary localities. 

As to treatment, while it is supporting 
and antispasmodic, as well as anodyne, yet 
the main dependence has been Flexner*s 
spinal fluid, ». e,, serum. In spite of that, 
however, more than fifty per cent, of cases 
were fatal. It prevails also as the result 
of cold, dampness and malaria, as well as 
from unhealthy surroundings. We have 
had a long hard winter, and a cold, damp 
spring, but now, as the weather is getting 
warmer and there is plenty of sunshine, the 
disease has about disappeared in Louisville. 

I know it will be regarded as old-fash- 
ioned, heroic and perhaps cruel nowadays, 
but I have cured cases in the past by 
stretching a two-inch fly blister from the 
nape of the neck to the cauda equina; bound 
it on at night, and let it remain until morn- 
ing, when a hot milk and bread poultice 
was applied. When the blister was used, 
there was metastasis, and the patients re- 
covered. I have also arrested cases of 
mastoiditis by the use of fly blisters. I 
cured a case of inflamed and enlarged ovary 
by repeating local fly blistering and reliev- 
ing pain by hypodermatics of morphine and 
atropine. 

I also cured more than one case of acute 
laryngitis with suffocative symptoms by fly 



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THE MEDICAL SUMMARY 



blistering. Like venesection it has gone 
into a state of "innocuous desuetude," but 
it accomplished great results in its time, and 
should never have become obsolete. A phy- 
sician said, not long since, that any one 
who would employ fly blisters now, ought 
not to be allowed to practice. However, 
with his new-fangled serums, his patients 
die, all the same. 

D. L. Field, M.D. 
Jeffersonville, Ind. 



THE VERY BEST TONIC WE HAVE. 

Editor Medical Summary: 

I allude to ignatia. It will do work which 
no other remedy in the combined materia 
medica will do. I speak advisedly of the 
combined materia medica, as it is the duty 
of the progressive 20th century physician 
to utilize all the resources of all kinds of 
ethical medicine. Ignatia fills a place that 
cannot be filled by nux vomica or strych- 
nine, besides being a cerebro-spinal stimu- 
lant, it has qualities as a nerve sedative and 
reconstructive which make it an exceed- 
ingly valuable remedy in all weak and ir- 
ritable conditions of the nervous system. 
It should be used in many cases where the 
compound syrup of hypophosphites is now 
used, and also in many disturbed conditions 
of the female nervous system where bro- 
mides and chloral are now. 

Let me give a case : Some years ago the 
minister of the church to which I belong 
was working himself to death as rapidly as 
possible. He had been working under 
great nerve strain for several months build- 
ing a new church and doing about four 
men's work. He came to me saying that if 
he did not have something to strengthen 
his nervous system he would soon collapse, 
and his symptoms indicated that he was 
right. I gave him ignatia, cinchona calis- 
aya, and dilute phosphoric acid. He met 
me two days afterward and said, "What in 
the world was that medicine that you gave 
me, doctor; was it anything of a narcotic 
or habit- forming nature ?" I said most de- 
cidedly that it was not, and asked him what 
gave him that idea. He said, "Why, I 
never had anything act so quick and pow- 
erfully on my system in my life; it seemed 
to go right to the spot and be just what my 



nervous system had been cravirfg.'* In 
cases like his some of the credit for quick 
improvement is rightfully due the other 
remedies, as dilute phosphoric acid is 
a wonderful reconstructive remedy for a 
weak and fagged-out nervous system. Ig- 
natia is one of those peculiar vegetable 
remedies that will not reveal their true 
curative principles to chemistry. It con- 
tains a large percentage of strychnine, but 
its field of action is vastly different from 
that of nux vomica or strychnine. Its great 
value, which ought to be universally known, 
lies in the fact that it is the most powerful 
remedy we have to allay great nervous ex- 
citement, and at the same time give the 
patient permanent strength and improve- 
ment. The profession would have precious 
little use for the hypophosphites if they 
were more familiar with the reconstructive 
action of ignatia, cinchona and dilute phos- 
phoric acid. This tonic will give a man the 
greatest assistance in building up his pa- 
tients after any long and exhausting ill- 
ness like pneumonia, bronchitis, continued 
fevers, and protracted and exhausting la- 
bors. It is an excellent thing to check the 
night sweats which are so common with 
greatly exhausted patients. 

Now, if any of you are thinking of tr>'- 
ing this remedy or the tonic, please, please, 
don't go and get your prescription filled 
with U. S. P. fluid extract of ignatia or 
cinchona; you will not get the results if 
you do. Get the specific tinctures of igna- 
tia and cinchona, or if it is impossible to 
get them, get the normal tinctures. 

We should always remember that for any 
tonic, astringent, or reconstructive action, 
we must have cinchona and not quinine, 
and a good tincture of cinchona must be 
made of the cinchona calisaya or yellow 
cinchona. Many pharmacists make it 
from cinchona rubra or red bark, which is 
only fit for the compound tincture. Cin- 
chona and bryonia make an excellent pre- 
scription for atonic dyspepsia. 

Wm. M. Gregory, M.D. 

Berea, Ohio. 



An ointment of equal parts of vaseline 
and calomel applied freely every day will 
heal up a chancre as quick as any other 
method. 



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123 



RHEUBIATISM—ACUTE, SUBCUTE AND 
CHRONIC. 



Editor Medical Summary: 

The following outline of treatment for 
rheumatism has given me most excellent 
results, and I would be pleased to have the 
readers of The Summary try it on their 
cases, and report results. 

In both hospital and private practice, 
where I have had occasion to treat hundreds 
of cases in nearly all stages, I learned to 
rely on but four or five good drugs. 

Salicylates in acute, colchicum and sali- 
cylates in subacute, and iodides and cimi- 
cifuga in chronic cases. 
Acute Rheumatism. 

A. Absolute rest in bed until convales- 
cence is well established. 

B. The sick room should be well venti- 
lated and its temperature maintained at 65"- 
70" F. Draughts should be avoided. 

C. Flannel blankets should be used to 
cover the patient. 

D. Diet should be liquid and nourishing, 
milk being the best article of food. Farin- 
aceous matter, skimmed milk and seltzer 
water, butter-milk, egg-white during the 
febrile and painful stages. 

A regular diet of bland nutritious foods 
should be given as soon as possible after 
the symptoms have subsided. 

Hot Epsom salt baths every third day, 
followed by a brisk rub with coarse towel 
will soften the tissues and dissolve the im- 
purities in the skin. The effects of the 
heat alone will reduce pain, inflammation 
quiet the nervous system and increase the 
efficiency of the internal organs of elimi- 
nation. 

Take about two or three pounds of Epsom 
salts, dissolve in twenty gallons of water, 
as hot as you think the patient can stand it. 
If the rheumatic cannot walk he is liftci 
into the tub and remains in the solution for 
fifteen minutes, after which time he is well 
rubbed, covered with flannel blanket and 
put to bed. 

F. Locally. 

5^ Tinct. opii, 

Tinct. aconiti aa ^iv. 

M. Sig. — Put one tablespoonful of this 
mixture in three ounces of hot alcohol. 



Saturate flannels and wrap around the 
joints. 

G. Internally. 

9 Sodii salicylatis 5iij. 

Sodii bicarbonatis 5vj. 

Sodii bromidi 5iij. 

Phenolis gr. iij. 

M. et ft. chartulae No. 12. (Dispense in 
blue papers.) 

5t Acidi tartarici 3v. 

M. et ft. chartulae No. 12. (Dispense in 
white paper.) 

Sig. — Dissolve the contents of one blue 
and one white paper in half a tumbler of 
warm water. Drink while effervescent. 
Repeat this dose every four hours. 

H. After convalescence is well estab- 
lished give the following excellent tonic: 

^ Ferri citratis 5ij. 

Tincturae nucis vonicae 3j. 

Sodii iodidi 5ij. 

Aquae q.s. ad ^xij. 

M. Sig. — One teaspoonful in a wine 
glass of water three times a day. 

Subacute Rheumatism. 

5^ Morphinae sulphatis gr. xij. 

Atropinae sulphatis gr. 6. 

Mentholis J^s. 

Liniment chloroformi J^ij. 

M. Sig. — ^Apply to the joints with a 
flannel. Rub in well. 

Internally. 

5^ Lithii salicylatis 3vj. 

F. E. colchici 3iij. 

Sodii iodidi 3v. 

Syrupi et aquae aa q.s. ad Jx. 

M. Sig. — One teaspoonful in milk every 
four hours. 

Bowels are kept open with sodium phos- 
phate. 

Flannel underclothing is worn the year 
round. 

Dampness and undue exposure is avoid- 
ed as much as possible. 

Chronic Rheumatism. 

Epsom salt baths at home will save your 
patients the expense of hot springs and 
various mud baths advertised in different 
parts of the world. 

Keep bowels open daily with vegetable 
cathartic pills. 



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THE MEDICAL SUMMARY 



Massage the painful and enlarged joints 
with the following: 
9 Extracti arnicae, 

Extracti belladonnae 3iv. 

Extract opii, 

Petrolati q.s. 5"- 

M. Sig. — Massage well into the joints 
three times a day. 

Internally the following formula is 

HIGHLY recommended: 

9 Acidi salycili 5iij. 

Fid. ext. cimicifugae 3vj. 

Kali iodidi 3iv. 

Tinct. gelsemi Jiij. 

Aquae q.s. ad Jx. 

M. Sig. — One teaspoon ful in wine glass 
of water three times a day. 

Another valuable formula used in 
chronic rheumatism is: 

9 Kalii iodidi 3ij. 

Vini colchici,. 

Tinct. opii camphoratis aa 3v. 

Tinct. cimicifugae 3v. 

Elixiris simplicis q.s. ad Jviii. 

M. Sig. — One spoonful three times a day. 

A. Charbonneau, M.D. 

606-7 Minahan Bldg., Greenbay, Wis. 



HONDBSCRIFT HOMEOPATHIC SUBSTAN- 
CES USED AS A REMEDY OR 
A MEDICINE. 



Editor Medical Summary: 

1 observed under the heading of "Simi- 
mary Gleanings/' you say if you have made 
any discoveries, please report them to the 
Summary. Now, perhaps you may not 
know that whenever a new theory, even to 
the establishing of a fact in medicine, is 
advanced, which is a deviation from the 
rank and file of the profession; from that 
of habit, custom, tradition, superstition, ig- 
norance and antiquated mythology, meta- 
physics, of a metaphysical type, that has 
emanated from thousands of crack-brained 
subjects who escaped confinement in an in- 
sane asyltmi, and instead drifted into the 
medical profession, which upon careful ex- 
amination is found to contain nine per cent. 



of its members who should term themselves 
charter members of a Devil's Science Club. 

When you open a homeopathic materia 
medica and look over the list of over 5000 
so-called remedies, and 100 of those sub- 
stances hell-born in character, and over a 
score out of the hundred too vile, too loath- 
some, to be permitted to be mentioned even 
in obscene yellow-back literature or white 
slave traffic, your memory will carry you 
back to the discoveries of Wm. Harvey, 
M.D., Benjamin Franklin, Galvani, Edward 
Jenner, M.D., Samuel Hahnemann, M.D., 
Davy, Michael Faraday, Wm. Thos. Green 
Morton, M.D., down to Prof. Roentgen's 
discovery, in 1895. 

The ridicule and scoffing down to the 
leering grimaces and satanic smiles that 
are heaped upon the so-termed crazy fool 
who dares to produce a thought above the 
common universal jargon of medical rot. 
I realize how the profession, a perfect 
fool's paradise, is over-crowded with de- 
plorable mediocre material medical doctors ; 
or Doc. for short; for I have to deliver a 
message of vital import, even equal to any 
of those mentioned from 1619 up to 1895. 
I have corresponded with professors at 
Ann Arbor, Chicago, Cleveland, Iowa City, 
New York, Philadelphia, San Francisco 
and Washington, D. C, and while each one 
was backward about saying that I was 
right, there was one exception, that of Gias 
Jones, M.D., of Cleveland, O., ex-President 
of the American Institute of Homeopathy. 
He thought the article of some importance ; 
all the others had either a cowardly or a 
feeble reply, something similar to, Why, I 
could not practice homeopathy without 
some such a remedy as lachesis, cantharis, 
medorrhinum, etc., etc. 

I would cease to practice homeopathy or 
any other school of medicine if I could not 
find and use a sensible clean substance for 
a remedy or a medicine. My title for this 
article is nondescript homeopathic sub- 
stances used as a remedy or a medicine. I 
have a list of 20 substances christened a 
red-letter list, then I have 80 under the 
head of nondescript articles. You will ob- 
serve that I refuse to name them by the 
sacred name of a remedy or a medicine, 
owing to the lack of respectability being 
shown in the selection and the want of 



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THE MEDICAL SUMMARY 



i«5 



sense in not discriminating as to what 
should constitute a remedy or a medicine. 
Even with the Council of Pharmacy and 
the A. M. A. this evil, crime and sin has 
not been brought under legal restriction. I 
wrote to Dr. Wiley in reference to filthy 
substances used as medicine, and requested 
him to turn his attention to the horrid 
curse being carried to such a frightful de- 
plorable condition in the twentieth century 
of a civilized intelligence. But he chose of 
the two evils the easier of the two. He re- 
signed in preference to undertaking such 
a monumental task of protecting the af- 
flicted common people — the public. He 
could fight foodstuff, the adulteration of 
liquors, wines, beer, etc., but refused this 
vital issue of demanding a higher standard- 
ization of substances for a remedy or mod- 
em therapeutics of the twentieth century, 
establishing a new era for the preservation 
of the sick. 

Theo. F. Johnson, M.D. 

1409- 1 1 Second St., Perry, Iowa. 



TYPHOID FEVER CASES WHICH WERE 
OUT OF THE ORDINARY. 



Editor Medical Summary: 

Last siunmer I attended a family of five 
children, the oldest boy of nine years, the 
mother of the family having died some six 
months previously, all the children, begin- 
ning with the oldest, having typhoid fever. 
They were attacked at the rate of one 
about every five days until all were ill, the 
youngest being a little over a year old. All 
recovered although they were all kept at 
the parental home, the father a laborer in 
a factory, a housemaid with the aid of one 
of the ''Little Sisters of the Poor*' during 
the day being the nursing provided. 

The first one attacked, the boy of nine, at 
about the close of the second week began 
peeling off from a severe dermatitis, not 
only the epidermis, but the true skin peel- 
ing off over the whole of the chest and 
abdomen, so that the surface was as raw 
as beefsteak and had to be carefully pro- 
tected with soft dressings and inunctions, 
and his suffering was great despite all the 
care. He was a very patient, brave and 



manly little fellow though and endured it 
all with much less complaint than would 
have been expected, or than would have 
been justified. 

As the healing of the raw surfaces pro- 
gressed, boils of varying sizes, from the 
size of a pea to a hickory nut, and a few 
considerably larger, formed over the de- 
nuded parts, and over the arms and legs, 
and in the scalp, so that I opened from half 
a dozen to a dozen and a half every day 
for at least two weeks. He was very much 
emaciated, as might be expected, but made 
a fine recovery. 

The second patient, a girl of seven years, 
had a similar experience as to the peeling 
of the skin, but not so extensively. The 
others were not thus effected. 

Another case, a boy of 11 years, who is 
now at home again from the hospital, where 
he was treated for three weeks, is now con- 
valescing satisfactorily, although not fully 
recovered. This patient became delirious 
about the third day of his sickness, and 
was as crazy as the proverbial bedbug for 
over two weeks, a very hard patient to 
take care of, for unless watched every min- 
ute he would jump out of bed and run about 
the ward. Before the end of the first week 
he was covered with the sudaminous red 
spots, not only over his abdomen, but over 
his whole body. His temperature ran from 
104" to 105" F. per rectum for over two 
weeks, his tongue was black and dry, and 
he looked as though he would surely die. 

These two cases are reported because of 
their unusual manifestations, unusual at 
least in my experience, which has been 
pretty extensive in the treatment of typhoid 
fever in the thirty-three years of my life 
which have been devoted to the practice of 
medicine. In all the time I have practiced 
medicine I never before had a case that 
had such severe desquamation nor any in 
which the red spots were so general over 
the body. In my experience the spots men- 
tioned have more frequently been difficult 
to find in satisfactory distinctness or 
numbers. S. L. Kilmer, M.D. 

South Bend, Ind. 



Adenoids in children cause greater sus- 
ceptibility to croup, laryngitis, bronchitis 
and pneumonia. 



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.^£^ 







The New Pocket Medical Formulary, 
With an Appendix, Containing Formu- 
lae and Doses for Hypodermic Medica- 
tion; Posological Table; Table of Apoth- 
ecaries' and Metric System of Weights 
and Measures; Fractures, Dislocations 
and Sprains ; Ligations of Arteries ; Hem- 
orrhages and Wounds; Poisons and An- 
tidotes ; Miscellaneous Emergencies ; 
Tables of Differential Diagnosis, Diet 
Lists for Various Diseases; Formulae for 
Fluid Foods, etc. By William Edward 
Fitch, M.D., Editor of Pediatrics, Ad- 
junct Attending Gynecologist Philan- 
thropian Hospital; Assistant Attending 
Gynecologist Presbyterian Hospital Dis- 
pensary ; Attending Physician to the Van- 
derbilt Clinic, College of Physicians and 
Surgeons, New York City, Etc. F. A. 
Davis Company, Publishers, Philadelphia. 
1912. Price, $2.00, net. 

There are quite a number of formulae 
books on the market, almost all similar in 
their make-up. The only difference in 
many is in kind of formulas selected, the 
compiler seldom incorporating much from 
his personal experience. The present little 
book, however, is an exception to the rule, 
and appears to be one of the. most carefully 
prepared books of the kind that has ever 
been brought to our notice. It has distinc- 
tive features not to be found in similar 
books; for instance, diseases are arranged 
alphabetically and the formulae given under 
the head of the disease for which presented. 
A feature worthy of attention is the double 
system of cross-indexing, by which the 
reader readily refers to other sections hav- 
ing a corresponding relation to the disease 
under consideration. Still another feature, 
not the least important, is the clinical 
hints following the headings of the more 
important diseased conditions and the ex- 
tensive table of "Differential Diagnosis" of 



the maladies likely to be confounded. The 
book also contains an excellent diet list, 
numbered and referred to throughout, w^hen- 
ever dieting would seem to play an impor- 
tant part. In fact, this pocket-sized book 
of 500 pages, on especially thin opaque 
paper, bound in fine flexible leather, will be 
found among the very best of its class, a 
pocket practice, as it were, and no physi- 
cian will make a mistake by having it close 
at hand, or with him in a side pocket in his 
round of daily practice. 



The International Medical Annual. A 
Year Book of Treatment and Practition- 
er's Index. E. B. Treat & Co., Publish- 
ers, 436-438 Benezet Bldg., New York 
City. 191 2. Price, cloth, $3.50, net. 

The 1912 edition, or thirtieth year of the 
appearance of this standard review of 
medical progress, if anything, is at least, in 
some respects, an improvement on previous 
editions, as it well might be, because of the 
author's constant aim to improve the sys- 
tem for producing only the most important 
matter, crystallized and so arranged that it 
becomes immediately available for refer- 
ence. 

This most excellent annual is without a 
peer, for size and practical worth of con- 
tents. No other single volume, published 
annually, will keep the physician so thor- 
oughly abreast of the times, up-to-date in 
all that is new in the different branches of 
medicine. It contains the sap of medical 
progress during the past year, and no one 
can go amiss in procuring this volume for 
reference. Doctor, do not waste, your 
money by putting it into large encyclopediac 
works, consisting of half-dozen or more 
volumes in a set, as before the last of such 
a set appears the first has become almost 
worthless. 



126 



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THE MEDICAL SUMMARY 



127 



Dyke's Automobile Encyclopedia. Sec- 
ond Edition, Revised and Enlarged. In 
40 parts, including a Dictionary, Index 
and 175 Charts, treating on Construction, 
Operation and Repairing of Automobiles 
and Gasoline Engines. By A. L. Dyke, 
E.E., Member Society of Automobile En- 
gineers. A. L. Dyke, Publisher, St. Louis, 
Mo. 1912. Price, $3.00. 

This is a thoroughly practical book for 
the busy auto owner; one that has eliminat- 
ed all theory and difficult problems. Every 
thing is put before you in a practical and 
right-to-the-point manner. Here we have 
40 instructions, divided into subjects such 
as: Assembly of a Car, Engine, Carburet- 
ors, Ignition, Magnetos, Storage Batteries, 
Cooling, Lubrication, all ordinary Repairs, 
How to Build a Garage for the Home or 
Business, How to Choose a Car, How to 
Buy a Second-hand Car. State laws of all 
States and Canada. Specification of all 
leading 1912 cars and how to tell exactly 
how they are constructed. Questions asked 
on various troubles, and their Answers; 
and last but not least, a complete diagnosis 
and remedy for all trouble the auto is heir 
to. Other important features of the book 
are the 175 large charts which it gives and 
which are simplicity in themselves alone. 
It also has a complete index. This volume 
contains 500 pages handsomely printed and 
bound. 

The Story of a Doctor's Telephone — 
Told By His Wife. By Ellen M. Fire- 
baugh, author of "The Physician's Wife." 
340 pages. The Roxburgh Publishing 
Co., Publishers, Boston, Mass. 1912. 
Price, cloth, $1.25. 

This certainly is a delightful novelty in 
literature, "The Story of a Doctor's Tele- 
phone." It is not Mrs. Firebaugh's first 
book or literary attempt. "The Physician's 
Wife," her first book, was published by The 
F. A. Davis Co., of Philadelphia, almost a 
score of years ago. It was well received, 
and we are informed is in liberal demand 
from its publisher even at the present day. 

There is no doubt about the telephone 
having revolutionized the doctor's life, but 
another close second is the automobile. 
Both are modem conveniences for the doc- 



tor, though while the latter is sometimes 
detrimental to our well-being, it may have 
destroyed life; in the hands of the doctor, 
both the 'phone and the automobile have 
undoubtedly been the means of saving lives, 
for there are times when ten or fifteen 
minutes saved mean much. 

In this "The Story of a Doctor's Tele- 
phone," Mrs. Firebaugh supplies in a bright 
and original manner all sorts of incidents, 
comic, pathetic, grave, gay and lively. The 
story is very simple, but true and full of in- 
terest, so that the reader will enjoy it, 
especially physicians. 

Compendium of Diseases of the Skin, 
Based on an Analysis of Thirty Thous- 
and Consecutive Cases with A Thera- 
peutic Formulary. By L. Duncan Bulk- 
ley, A.M., M.D., Physician to the New 
York Skin and Cancer Hospital; Con- 
sulting Physician to the New York Hos- 
pital; Consulting Dermatologist to the 
Randall's Island Hospital. Fifth Revised 
Edition of the "Manual Diseases of the 
Skin." 8vo. 300 pages. Paul B. Hoeber, 
Publisher, 69 E. 59th St., New York City. 
1912. Price, cloth, $2.00. 

For many years Dr. L. Duncan Bulkley 
has been a recognized authority on diseases 
of the skin, and it is fourteen yea^^s since 
his famous "Manual of the Disease of the 
Skin" first made its appearance. Now we 
have before us a copy of the fifth edition, a 
revised, much improved and brought up-to- 
date work before us. This book is essen- 
tially a practical one, intended for the use 
and guidance of the general practitioner. 
The text matter is followed by about a 
dozen pages of reliable prescriptions which 
are referred to in the text by number, so 
that no prescriptions are embodied in the 
text matter. This is followed by a com- 
plete index. The book is up-to-date, con- 
cise, authoritative and rational. The repu- 
tation of the author is alone a sufiicient 
guarantee for its practical worth. 



A few drops of a one per cent, solution 
of silver nitrate instilled into the eyes of 
new-bom children is never harmful, and 
may prevent an attack of ophthalmia neo- 
natorum. 



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^ttmmarg (Sl^aninp 



An eruption resembling scarlet fever may 
follow the administration of quinine. 

For erysipelas paint with pure carbolic 
acid and follow with alcohol immediately. 

Sponging with a one-in-eighty solution of 
creosote in alcohol is excellent in the treat- 
ment and prevention of bedsores. 

In laryngismus stridulus or false croup, 
look for adenoids, enlarged tonsils, disor- 
ders of digestion or worms. 

When strong solutions of silver nitrate 
are applied to the eye they should be neu- 
tralized by solution of sodium chloride. 

Erysipelas causes an infiltration of the 
tissues which has a border line that can be 
distinctly felt by the fingers. 

A saturated solution of picric acid is very 
serviceable in acute eczema, but of no use 
in chronic types. 

Measles is the most contagious of all the 
infectious diseases, with the possible excep- 
tion of smallpox in the unvaccinated. 

In fungous endometritis and in the met- 
rorrhagia of uterine fibroids potassium io- 
dide is well worthy of trial. It may also be 
tried in cases of threatened abortion. 

Calcium sulphide, 34 grain every two 
hours, is very useful in ^beginning boils, 
carbuncle, or in any acute suppurative con- 
dition. 

Strontium bromide is highly commended 
by Germain-See in fermentative dyspepsia. 
It is distinctly less irritating than potassium 
bromide and is a valuable nerve sedative, 
while its influence on the circulation and 
gastro-intestinal tract is most kindly. 

Sir Dyce Duckworth in the British Medi- 
cal Journal, says that the man who with- 
holds a remedy that has been found valu- 
able because he does not understand its 
action is not a truly scientific practitioner. 



Impotence is an important symptom in 
sexual neurasthenia. In fact, in the eyes 
of the patient it is the dominant symptom, 
and is the one thing which compels the sex- 
ual neurasthenic to seek medical advice. 

Experience shows that the thoroughly 
ripe banana (or the less ripe fruit, after 
cooking), is undeserving of the unfavor- 
able reputation which it has won in certain 
quarters. It forms a useful addition to the 
dietary, richer in nutrients and far more 
delicious than some of its more expensive 
competitors. — American Practitioner. 

In flatulent dyspepsia, three drops of oil 
of cajuput on a piece of sugar or crumb of 
bread, taken frequently, is worth all the 
other antifermentatives put together. It is 
not only antiseptic but agreeable. — Murrell. 

Thiersch's fluid is made up of i6 grains of 
salicylic acid and 96 grains of boric acid 
dissolved in a pint of sterile water. This 
is cleansing for mucous membranes, such 
as those of the mouth and eye, and it may 
be used whenever irrigation is employed 
for cleansing purposes. 

Dr. Stark is emphatic in the belief that 
to give quinine to a person suffering from 
influenza, with severe headache, furred 
tongue and acute pain in the limbs, merely 
adds to his discomfort. He cuts the dis- 
ease short in two days, he says, by giving a 
mercurial purge, followed by sodium sali- 
cylate, potassium bicarbonate and tincture 
of nux vomica. — "Practitioner/* 

Put into a tumbler about two ounces of 
strong lemonade, using nearly half a lemon. 
Pour in the desired quantity of castor oil. 
Just as you are ready to give it stir in 
about one-quarter teaspoon ful of baking 
soda. It will foam to the top of the glass. 
Have the patient drink it while it is effer- 
vescing. Even the oiliness of the dose is 
not detected. — "Trained Nurse" 



128 



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HEAT PROSTRATION. 

Ice or cold applications to the head are 
almost invariably indicated. If the face is 
flushed, the skin red and hot, the pulse 
bounding and the heart acting tumultu- 
ously, the entire body should be rubbed 
with ice or bathed with cold water. Cold 
drinks are indicated. If the surface of the 
body is cool, use warm applications, mus- 
tard to the feet and internally hot drinks, 
whiskey, ammonia, etc. 



TH£ jmnSNILB COURT. 

Oh, my ! The wail of graft or crooked- 
ness comes to us from all sources these 
days, even from the charity workers and 
their institutions. In a recent number of 
Good Housekeeping Winifred Black gives 
detailed abuses imposed upon helpless chil- 
dren by probation officers and the juvenile 
courts. The writer does not "allege" what 
she presents, but gives it as cold-blooded, 
undeniable truth. It is claimed that in the 
city of Chicago 5,000 children are yearly 
declared delinquent and are disposed of in 
various ways. Some are sent to institu- 
tional homes and many are sent out to find 
homes on farms. The writer states that 
the time taken by a probate judge in the 
city of Chicago — with which city she seems 
more familiar — to investigate the record of 
a boy or girl is fifteen minutes, and most 
of his information is obtained from the 
probation officer, who too often is an ig- 
norant or indifferent person. If what this 
writer states is- the truth it is a very easy 
matter for the probation officers and the 
juvenile courts to separate a poor child 
from his parents for good and all. She 
asserts that, were Abraham Lincoln a little 
urchin running about most any large city- 
to-day, he would run the risk of being haul- 
ed into court and railroaded off into some 
institution with a lot of amateur thieves 
and criminals. It is claimed that many 
children that are in no wise vicious must 
be associated with those of more corrupt 



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THE MEDICAL SUMMARY 



tendencies. If Garfield, McKinley, Grant 
or Lincoln had lived to-day in any large 
city they would perhaps have succumbed 
to the probation officer. 

Now the main point which the writer 
wishes to make is this: A sort of charity 
trust prevails throughout the country, and 
in order to feed the juvenile courts, "busi- 
ness" must be secured by some hook or 
crook. This institution is among the last 
which we should allow ourselves to think 
of becoming contaminated, and we can 
scarcely believe all the writer says. If, 
however, it be truth the limelight of pub- 
licity should be made to shine brilliantly in 
places so dark. Whether it is apropos or 
not, we are reminded of the old saw that 
charity sometimes becomes so elastic as to 
conceal a myriad of wrongdoings. 



SANITARIUM TREATMENT OF TUBERCU- 
LOSIS IN PRIVATE PRACTICE. 

The above is the title of a reprint article 
from the J. B. Lippincott Company, the 
author being Dr. J. H. Mudgett, a success- 
ful practitioner of Philadelphia. The writ- 
er points out certain advantages that result 
from home treatment, especially the fact 
that the patient does not do well when 
changed from one environment to another. 
Generally speaking, he should remain in 
that one to which he has become accustom- 
ed and attuned The Summary has often 
called attention to the fact that the money 
necessary to send a patient ofT to a con- 
sumptive mecca and maintain him there in 
comfort will give better results if applied 
in providing suitable home treatment 

Dr. Mudgett points out the symptoms 
which call for rest. They are: (i) fever, 
(2) hemorrhage, (3) rapid respiration, (4) 
rapid pulse, (5) loss in weight. The pa- 
tient should remain in bed until the tem- 
perature is normal for a period of thirty 
days, and until there is no blood in the 
sputum, respiration and pulse are slowed 
down, and there is an apparent increase in 
weight. These are sensible and conserva- 
tive ideas. Contrast it with the fact that 
thousands of poor unfortunates who, from 
necessity or choice, work until life has al- 
most ebbed away ! 



The author also speaks of tuberculin 
coming more and more into use. "When 
carefully and intelligently administered," 
he states, "tuberculin, in addition to the 
ordinary hygienic and dietetic measures, 
which are now so well and so generally 
adopted, constitutes our greatest therapeu- 
tic resource. I use the tuberculin injection 
once a week in all cases, except advanced 
ones, even when there is a temperature of 
102 or 103. In most instances tuberculin 
will assist nature and save the destruction 
of the lung." 

Dr. Mudgett h&s also found the mixed 
vaccines in conjunction with the tuberculin 
to be of great value in reducing tempera- 
ture. Each is given once a week. Accord- 
ing to the author the best results in cases 
accompanied by fever were obtained from" 
a modified form of Koch old tuberculin, 
made by the St. Petersburg Tuberculin So- 
ciety, and known as Tuberculinimi Purum 
Endotin. This treatment is followed with 
the Denny tuberculin emulsion. The doc- 
tor gives a number of reports of cases in 
which he shows the beneficent results of 
this special therapy. In conclusion, the 
writer says: '*(i) Patients should be treat- 
ed at home instead of sending them, to a 
sanitarium. (2) Rest is the best treatment 
for tuberculosis. (3) Open-air method 
should be used when possible. (4) Tuber- 
culin should be used in nearly all cases ex- 
cept advanced ones. (5) If diagnosis is 
made early, a large per cent, of cases can 
be cured or arrested." 



EUGENICS. 



This is a comparatively new science, 
dating back but two or three decades. We 
usually think of eugenics as the science of 
bettcrinjB^ the human race by safeguarding 
the conditions preceding birth. It is clear 
to even the humblest student of biology 
that many of the handicaps which beset 
humanity could be weeded out if certain 
physically and mentally unsound persons 
were prevented from procreating. This 
movement is constantly gaining strength 
and deserves the support of every good 
citizen whose pulses thrill with the instinct 
of race betterment. Jails, almshouses and 



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I3» 



eleemosynary institutions are all right in 
a way, but there should not be a necessity 
for so many of them. 

The Church Federation Council of Chi- 
cago has officially endorsed the stand taken 
by Dean Sumner, of that city, a few months 
ago in announcing that hereafter all cou- 
ples presenting themselves for marriage 
must produce physicians' certificates show- 
ing an approved physical condition before 
a ceremony can be performed. The Illi- 
nois Homeopathic Medical Association has 
also endorsed this movement, and numer- 
ous other medical bodies have the matter 
under advisement. Several States have by 
their legislatures enacted laws by which 
criminals and physically and mentally in- 
competent individuals may be sterilized, 
thus putting a stop to a stream of progeny 
which is so often vicious. An epileptic, or 
imbecile, or pervert may possibly produce 
a brilliant offspring, but it*s many times 
more likely that the offspring will be no 
better than the parent. In such instances 
mental and physical deterioration are more 
common than improvement. The purpose 
of eugenics is to prevent people yet unborn 
from being improperly bom. 



BICHLORIDE OF MERCURY. ' 

To asseverate that this is a powerful, 
two-edged agency is another case of **car- 
rying coals to Newcastle." A fatal inter- 
nal "dose" is about three grains. The 
symptoms are gastro-intestinal in character 
with nausea, vomiting and later purging if 
the person survives sufficiently long. Al- 
bumin appears in the urine and uremic or 
nephritic poisoning occurs. In case of in- 
gestion of a toxic dose of bichloride the 
stomach should be promptly lavaged. Milk 
and eggs may be given with a view to 
forming an insoluble compound in the 
gastro-intestinal tract and also as a pro- 
tection to the denuded mucous membranes. 
Colloidal silver is said to effectively anti- 
dote the poison if given sufficiently early. 

As a local germiddal agency bichloride 
of mercury has during the past been em- 
ployed too frequently and often recklessly. 
Used locally it is destructive of most patho- 
genic micro-organisms. Incidentally it in- 



hibits the proliferation of normal cells. It 
goes after friends as well as foes. It is an 
unfortunate fact that promoters of reme- 
dies to prevent conception are combining 
this powerful agency with other drugs in 
tablet form. Women are learning the value 
of this drug as a means of cheating nature. 
We called attention recently to a case of 
death resulting in this manner. It would 
be better for physicians and patients alike 
if bichloride of mercury were not put up in 
lethal doses and for internal use only. As 
a local agency it is seldom needed. 



THE TREATMENT OF GONORRHEAL 
URETHRITIS. 



It is an old, old topic, yet it seems that 
we can not settle to the satisfaction of 
every one the best treatment for acute 
gonorrhea. Much is still being written on 
this subject, and writers are far from be- 
ing in accord in any one established line 
of therapeutic procedure, but we believe 
that a uniformity of opinion is much nearer 
now than existed a decade or so back. 

Dr. E. J. Angle in an article in May 
Clinical Medicine, gets down to brass tacks 
and records a good deal of his personal 
experience in handling this disease. Milk 
diet is especially recommended as well as 
the drinking of water in copious quantities. 
He urges upon the patient a restricted diet, 
the avoidance of condiments, acid fruits, 
etc. The most reliable remedies for inter- 
nal use during the first ten days are, in his 
opinion, methylene-blue, salol, boric acid, 
helmitol and urotropin. After the acute 
symptoms have subsided the balsams are 
indicated, and the best of the group is oil 
of sandalwood. "Cubebs and copaiba," says 
Dr. Angle, "have been relegated to the 
graveyard of obsolete therapeutic agents." 
The usual dose of sandalwood oil is lo 
minims, which can be increased to 20 in in- 
dividuals with good digestion. Other san- 
dal-oil derivatives which the writer asserts 
are just as efficacious and less prone to af- 
fect the digestion or congest the kidneys 
are santyl-KnoIl, gonosan, lacto-santal and 
stearosan. 

While oil and sandalwood is the nearest 



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THE MEDICAL SUMMARY 



thing to a specitic we possess in posterior 
urethritis, yet a valuable adjunct to it is 
atropine, especially in cases where urina- 
tion is unduly increased or painful. The 
sitz bath prolonged for a half-hour and 
taken several times daily lessens tenesmus 
and the desire to urinate. Codeine may 
also be needed and occasionally opium and 
belladonna suppositories. Chordee is best 
controlled with 5-grain doses of monobrat- 
ed camphor and the application of an ice- 
bag. 

The writer states that with a view to de- 
stroying the gonococcus he confines him- 
self to four silver salts, namely, albargin, 
argyrol, protargol and hegenom. Each pre- 
paration has its individual indications. The 
technique and manner of use of these 
agents are all-important matters. Only 
relatively few gonorrheal cases are suitable 
for abortive treatment. It is not his cus- 
tom to use astringents as long as gonococci 
remain, and after their elimination there 
are few cases in which a discharge re- 
mains. The writer calls attention to the 
fact that the irrigation method of treating 
gonorrhea has passed out and also that 
gonococcic bacterin is entirely without 
value in acute gonorrhea. 



TWO IlfSTRUCTIVB REPRINTS RECEIVED. 



We have received reprints of two arti- 
cles written by Dr. A. Rose and published 
in New York Medical Journal. One of 
these is "Treatment of Phymatiasis by 
Means of the Continuous Bath." By the 
way, reader, do you get the word "phy- 
matiasis'*? The writer reports a case of 
hectic fever, cough, expectoration, etc., ac- 
companied by enormous cedema of the left 
lower extremity. The sputum contained 
tubercle bacilli, so the diagnosis was an 
acute miliary phthisical infection of the 
lungs. Continuous bath treatment for one 
month improved her condition in every way 
and the sputum at that time was free from 
bacilli ! The other reprint is "Some New 
Ideas Concerning Phymatiasis (Tubercu- 
losis)." Dr. Rose points out the value, in 
his opinion, of abdominal strapping in or- 
der to prevent atonia gastrica and thus 



conserve the tone and function of the stom- 
ach. He also states that tubercle bacilli 
can not thrive where an excessive amount 
of carbonic acid is present. Attention is 
called to the fact that the success of Dett- 
weiler's treatment is mainly due to the re- 
cumbent position of the body favoring the 
accumulation in the lungs of venous blood 
which is surcharged with carbonic acid. 
It is pointed out that laborers in lime kilns 
remain immune against phymatiasis. In 
their case the diffusion of gases is made 
more difficult, elimination of carbonic acid 
being to a certain extent prevented. The 
simplest way of introducing carbonic acid 
into the system is by inflating the rectum 
with it. This procedure and the continuous 
warm bath are highly extolled by the writ- 
er of these articles. Doubtless these re- 
prints may be obtained by those interested 
by writing to Dr. A. Rose, 173 Lexington 
avenue, New York. 



ATTENTION TO DETAILS. 



A successful surgeon remarked to the 
writer once that he owed most of his suc- 
cess to painstaking attention to details, the 
little trifling things that are to so many a 
source of annoyance. Every detail of an 
operation is gone over before smarting it, 
and preparation made for every untoward 
circumstance that is likely to arise. Some 
one has aptly said that if we prepare for 
emergencies they will never occur. Pre- 
paration is certainly a good means of cir- 
cumventing many of them. We are all 
compelled to give attention to a great 
many small matters during the course of 
the day or week — matters that in them- 
selves perhaps contribute very little to our 
sum of happiness or wealth, yet failure to 
get rid of these only results in their clog- 
ging the machinery of more important af- 
fairs. Some men seem to have a knack 
of turning off a good volume of business 
and find* time for many things. This is 
largely due to their system of handling the 
business, both great and small, that con- 
fronts them, and by doing what needs to 
be done promptly, thus opening the way to 
something else. 



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TRACHOMA. 

By J. M. Leonard, M.D. 

Trachoma is an inflammatory disease of 
the conjunctiva, due to infection, and ex- 
tremely chronic in character. Undoubtedly 
bacterial in origin, it is most often found 
where people live in close proximity under 
bad hygienic conditions, but it must not be 
forgotten that trachoma is no respector of 
persons and may be found among the most 
cleanly. Trachoma is a disease common to 
nearly all peoples, and contrary to the old 
belief is found at high as well as at low 
altitudes. 

During the past few months I have seen 
a number of cases of trachoma among the 
school children of this city, discovered dur- 
ing an inspection of the children's eyes by 
the authorities. Much of the trouble dis- 
covered was diagnosed as trachoma, and 
this brings us to the question of diagnosis. 
Developing insidiously as it does, the pa- 
tient is often in complete ignorance as to 
bis condition until chance examination re- 
veals it. In the early stages it is impos- 
sible to distinguish trachoma from acute 
catarrhal conjunctivitis until the case has 
been under treatment at least six weeks. 
If at the end of that time granulations per- 
sist, together with a mild degree of in- 
flammation, we have considered ourselves 
safe in diagnosing the disease as trachoma 
and treating it accordingly. 

For a detailed account of the symptoms 
of trachoma the reader is referred to any 
good text-book on diseases of the eye. 
Suffice it that a positive diagnosis is justi- 
fied when with a slight degree of inflamma- . 
tion we have granules of a sago grey color, 
varying in size, appearing on both lids, and 
persisting in spite of treatment. 

Neglected trachoma may after reaching 



the stage of full development remain un- 
changed for a long time, may have periods 
of exacerbation, and may progress rapidly 
even to destroying sight. It therefore be- 
hooves us to treat trachomk vigorously and 
persistently. The method used in this of- 
fice among the children has been as fol- 
lows: During the first six weeks a 20 per 
cent, solution of argyrol is rubbed strongly 
into the lids twice weekly, in severe cases 
oftener, washing daily with boric acid so- 
lution. At the end of this time we begin 
using copper sulphate, starting with one 
part of a 10 per cent, solution in glycerin 
in fifteen parts of water and instilling one 
drop in each eye daily. The strength of 
the solution is gradually increased, cocaine 
being added to allay the pain as the strong* 
er solutions are reached. When used per- 
sistently this treatment will usually clear 
up the milder forms of trachoma. When 
it proves unavailing we have recourse to 
the stick or pencil of copper sulphate with 
which the granules should be vigorously 
rubbed. This treatment is extremely pain- 
ful and should be preceded by the instilla- 
tion of four per cent, cocaine solution. The 
lids should be rubbed twice weekly until 
the granules disappear or the physician is 
convinced the treatment is doing no good. 

Other means failing to effect a cure, we 
must consider curettage, rolling, manual 
expression, and the radical operation. The 
first three have the sanction of years and 
the merit of usual efficacy. The last has 
the endorsement of good surgery in that it 
gets rid of the diseased tissue completely 
and in this way offers the greatest hope of 
complete cure. 

Space does not allow me to go into de- 
tail as to these methods, but if the readers 
of this magazine care for a further article 
on this subject I will be glad to prepare it 

Calumet and Arizona Hospital, 
Bisbce, Arizona. 



133 



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t34 



THE MEDICAL SUMMARY 



THE PRACTICAL APPLICATION OF ELEC- 
TRICITY AS A THERAPEUTIC AGENT. 
GENERAL USES OF CURRENTS. 

By J. R. Etter, M.D. 



BDITOBIAL NOTE.— Tliif if tba third of Dr. 
Bttor • Mriei of short, practical articles. Each 
artielo will be complete in itself; the entire 
series, when complete, will form a regular 
twd^iMCMm on '*The Practical Application of 
Electricity as a TherapenUc Agent.** These 
articles will be something different, that is, 
they will be presented in a different form from 
the general run of matter hitherto brought out 
on the subject in the books. Ko general prac- 
titioner can afford to miss a single number of 
THE SXTMICABT containing this Series, which 
will run through all the present year and prob- 
ably the next, and will giTO the technique of 
application minus the theory. 



In this article, I will give a comprehen- 
sive view of the uses, in a general way, of 
the various currents as used in medicine; 
and, if the reader will keep the points here 
given in mind, he will be able to know at 
once what current will be most suitable for 
any given case, and can easily form a suit- 
able technique. To make it more plain, I 
might state that there are two general kinds 
of currents that enter into electro-thera- 
peutics, viz.: the steady or unbroken gal- 
vanic, and the interrupted or broken gal- 
vanic; classed with the latter is also the 
alternating. The steady galvanic is where 
there is a continuous flow of electricity 
through the tissues; in the interrupted, 
there is a iflow while the current is closed, 
but none at all when it is open. In all cases 
where an absorbing effect is desired, as in 
enlarged glands, deposits about joints, ef- 
fusions, etc., the steady galvanic would be 
the current indicated. The current alone 
may be used, but in most cases of this class 
medicines should be employed and driven 
into the tissues. This is known as cata- 
phorcsis, and the term will be often used. 
Then, where a mild cauterizing effect is de- 
sired, such as in chronic ulcers, chronic 
endometritis and other cases of this char- 
acter, the steady galvanic is the one to use. 

As has been mentioned, there are differ- 
ent kinds of currents — ^not really different 
electricity, but modifications which, by 



many authors, are classed as different cur- 
rents. In fact, it is the best way to de- 
scribe in articles of this kind the uses to 
which electricity may be put. If the reader 
will get fixed in his mind the different gen- 
eral conditions in which these currents are 
used, it will enable him to work out many 
of the problems in electrical treatment for 
himself. Therefore, I shall not minutely 
explain the different treatments of each 
.separate disease, but only mention a suf- 
ficient number that it will give a guide to 
the practitioner in his work. 

The first current I will mention is known 
as the steady galvanic, and its use is main- 
ly, if not altogether, in electrolysis. This 
current is used where it is desired to de- 
stroy or dissolve tissue, or where it is de- 
sired to drive medicines into the tissues, 
and in some cases to invite circulation to a 
part. As an instance of its use, I might 
remark here that, in the removal of warts, 
moles and superfluous hair, the destruction 
of tumors, and in cataphoresis, this current 
.would be used. It would be impossible to 
do this class of work with the faradic cur- 
rent. 

The second class of currents known in 
medical practice, might be known as inter- 
rupted currents, and is generally of very 
high voltage and small amperage, which is 
just the reverse of the galvanic currents. 
Among these are the interrupted galvanic, 
faradic, and sinusoidal, the latter current 
being a combined current, and first de- 
scribed ;.nd named by d'Arsonval, of 
France, as a combination of the interrupted 
galvanic and the alternating magnetic cur- 
rents. I have used this current more ex- 
tensively, and with greater benefit to my 
patients, than any other one single current. 
There are many currents described in the 
books now as sinusoidal, that I do not deem 
come up to the standard of the original 
description of this current by d'Arsonval, 
from the fact that they are usually gener- 
ated by ordinary magnetos. A short de- 
scription of the manner in which this cur- 
rent, that I have found so successful, is 
generated, might not be out of place at this 
time. The machinery is very simple, being 
an ordinary rotating motor — that is, a mo- 
tor with a soft iron armature revolving 
over the heads of charged magnets which 



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THE MEDICAL SUMMARY 



135 



generate the alternating current, the motor 
itself also interrupting, or breaking, the 
galvanic current, these two currents being 
carried together to the patient. It is im- 
possible to fulfill the description of the sin- 
usoidal current, as described by d'Arsonval, 
with a current generated by an ordinary 
magneto, as is being done in many in- 
stances at the present time. The great ad- 
vantage of the current described as sinu- 
soidal, is that we have consAderable quan- 
tity as well as high tension ; thus, to an ex- 
tent, this current has some absorbing effect, 
consequently its beneficial use in strictures 
of the urethra and fiexures of the uterus, 
as elsewhere described. The interruptions 
of the galvanic part of the current can be 
varied from two hundred to two thousand 
per minute, and of course the alternating 
magnetic part of the current can be in- 
creased or decreased in the same propor- 
tion. The more rapid the interruptions, 
the more anesthetic the effect. There are 
four alternations of the magnetic current 
to each interruption of the galvanic, in the 
machine that I use. The great advantage 
I find in this current is, there is a quantity 
in it much the same as the galvanic; but, 
of course, being interrupted at different in- 
tervals, it does not have the electrolytic ef- 
fect that a steady galvanic current has, and 
of course there is no danger of burning the 
skin or making a blister as in the steady 
galvanic current. The alternating mag- 
netic part of this current is of very high 
tension and, as other high tension currents, 
it has no appreciable quantity, but it acts 
as a sedative the same as other high ten- 
sion currents; so that, in the use of this 
current, we get, to a certain extent, absorp- 
tion, as we get from the galvanic, and we 
get the pain-easing qualities of the alter- 
nating magnetic, which make the currents 
generally used, and we do not have to first 
'Use a galvanic current, and then change 
off onto an entirely different current in 
order to ease the pain. I have thus di- 
gressed, in order that the reader may know, 
when I speak of the sinusoidal current in 
this work, what current I mean. 

In the second class of currents mention- 
ed above, I might OKntion the faradic, or 
induced, current, which is of very high ten- 
sion and of scarcely an appreciable quan- 



tity ; also, the static current would come in 
this classification. This second class of 
currents is generally used to exercise mus- 
cle, to soothe pain, to increase circulation 
in the part, and to arouse nervous action as 
in paralysis ; so it will be seen that the two 
classes of currents are used for two dis- 
tinct kinds of work. 

By keeping these facts in view, it will 
readily be seen that an ordinary physician 
may be able to select which class of cur- 
rents would be appropriate to the case in 
hand. In speaking of the use of currents 
where separate diseases are described in 
these articles, I will state the current that 
should be used in such diseases, so I do 
not deem it necessary to further extend 
this general classification. 

Demonstrations: Positive pole attracts 
acids; negative, alkalies. Met..iS are eaten 
away from the positive pole and carried to, 
or toward, the negative, as in the various 
modes of electroplating. It iv probably due 
to this separation of acids and alkalies, that 
we get results in rheumatism and other 
diseases. It should be mentioned that the 
positive and negative poles can only be 
demonstrated where the current is passed 
through a partial dielectric. It is impos- 
sible to demonstrate that there is a posi- 
tive and negative electricity, where the cur- 
rent is passing along a continuous metal 
wire. 

Wireless telegraphy has upset many of 
the accepted theories of the past, as to the 
necessity of metallic conductors, and opens 
up anew the field of discussion as to what 
electricity is — is it a fluid, or a sound wave, 
or a what? It has been known from time 
immemorial that lighting uses the air as a 
medium through which to travel, as also 
high tension currents, as the spark of the 
static machine or the Rhumkorf coil. 

Crawfordsville, Ind. 



Do not skip the advertisements in the 
Summary, Doctor. 



For a quick heart stimulant to overcome* 
a weak heart, especially if there is a palloi- 
of the tissues, nitroglycerin will be found 
useful. Give i/ioo of a grain hypodermi- 
cally every hour, or in desperate cases 
every half-hour until the heart improves. 



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THE MEDICAL SUMMARY 



THE TREATMENT OF ANGINA PECTORIS. 
By Israel Bram, M.D. 

This disease, with its awful sense of im- 
pending death, and its frequent fatal termi- 
nation, should be treated with a thorough 
knowledge of the causative factor and a 
comprehensive and careful armamentarium 
of appropriate medicinal agents. The first 
essential is a correct diagnosis. Angina pec- 
toris must be differentiated from pseudo- 
angina pectoris of the neurasthenic and 
hysteric patient, and also from certain other 
conditions, including palpitation. It must 
Jbc remembered that although the disease 
.in question may attack either sex and at all 
-ages, it is most frequently found in male 
adults past the age of forty. The causative 
factors are usually those leading to dis- 
*ease of the aortic valve or orifice, sclerosis 
of the coronary arteries, chronic myocard- 
itis with hypertrophy and sclerotic changes 
within the heart muscle, obstructions in the 
coronary arteries by thrombosis or embolus, 
pericardial adhesions, etc. A very potent 
indirect causative factor is syphilis, which 
must always be thought of when confront- 
ed by a case of angina pectoris. Other in- 
direct causes are prolonged physical exer- 
tion, chronic alcoholism, a gouty or rheu- 
matic diathesis and chronic lead and arseni- 
cal poisoning. The tobacco habit and a 
hereditary tendency must also be consid- 
ered. 

The treatment of angina pectoris must 
be divided into two large divisions, i. e,, an 
attempt to remove the cause, and the treat- 
ment of the disease itself. The measures 
embraced in the treatment are dietetic, hy- 
gienic and medicinal, which of course are 
thoroughly gone into between attacks. 
During an attack, however, measures are 
used for the relief of the urgent symptoms 
only. 

Treatment of the Attack. — An ice bag 
should be placed over the precordial region 
and the patient kept quietly in bed. Three 
to five drops of amyl nitrite placed on a 
handkerchief or piece of cotton, inhaled 
by the patient, often gives immediate re- 
lief. In more stubborn cases a hypodermic 
injection of morphine gr. ^, combined 



with atropine gr. i/ioo, repeated within a 
few minutes if necessary, usually results 
in relief of symptoms. However, some 
cases require enormous doses of the usual 
drugs before relief is attained. I can re- 
call a case in which the awful paroxysms 
continued for three hours despite numer- 
ous hypodermic injections of morphine, 
atropine and nitroglycerin. This latter drug 
was given in doses as high as gr. 1/20 re- 
peatedly without effect. Generally speak- 
ing, however, the ice cap, the amyl nitrate, 
the hypodermic injections of the aforemen- 
tioned drugs and a well-ventilated room 
usually suffice to tide the patient over his 
attack. 

Treatment Between Attacks. — The 
cause must be searched for and overcome 
wherever possible. In the case of the alco- 
hol or tobacco habit, or in chronic arsenical 
or lead poisoning, the treatment is obvious. 
A gouty or rheumatic diathesis must be 
treated along rational therapeutic lines. A 
hypertrophied heart due to prolonged phy- 
sical exertion should be treated by the 
proper amount of rest and careful dietary 
regulations; and a syphilitic system should 
be corrected by mercury, the iodides, and 
salvarsan. 

The diet should always be light, nutri- 
tious and sensible. Such articles as create 
production of large quantities of gas should 
be warned against. The bowels should be 
kept regular. Fresh air at all times and 
hydrotherapeutic measures are highly es- 
sential as adjuvants in the treatment. Phy- 
sical exertion and mental anxiety, worry, 
fear, etc., should be carefully interdicted. 
In other words, physical, and mental equa- 
nimity are of utmost importance in the 
treatment of this disease. 

In general it may be said that potassium 
iodide is the drug par excellence, to be 
used between attacks in conjunction with 
the aforementioned suggestions. It should 
be given in doses of from five to twenty 
grains t. i. d. according to patient's toler- 
ance. Some patients are also greatly bene- 
fited by sodium nitrate in doses of gr. j to iij 
t. i. d. for its dilatory influence on the ar- 
terioles. 

In conclusion I will state that there are 
cases of angina pectoris to be met with in 
private practice which are decidedly at- 



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typical in nature and may exhaust the usual 
means before relief is accomplished. 
1714 N. 7th St, Philadelphia, Pa. 



THE MAY SUMMARY. 

George L. Servoss, M.D. 



The May Summary is a particularly good 
number of a particularly good journal. 
The editor, in his suggestions, tells us a lot 
of good truths. His May musings should 
have the attention of every one of us. I 
would suggest that, in addition to his sug- 
gestion, that the doctor read much and 
well; every one of us should endeavor to 
write some for the journals. We all have 
ooraething to otfer which will be somewhat 
out of the ordinary and which will benefit 
our brother practitioners. He says that 
optimism is a great asset, and he is abso- 
lutely right. The pessimistic doctor, like 
ail other misanthropes, never made a suc- 
cess out of life. Remember that Ella 
Wheeler Wilcox says, "Laugh and the 
world laughs with you, cry and you cry 
alone." The later version is, "Knock and 
the world knocks with you, boost and you 
boost alone." Always try and be in the 
laughing class. A funny story will fre- 
quently do your patient much more good 
than will a big dose of medicine. Don't, 
for goodness' sake, carry a long face into 
the presence of your patient. 

Of course, you read the advs. in all your 
journals. If you do not, you frequently 
miss some of the best "stories'* which are 
printed between the covers. There is a 
lot to be learned from the adv. pages of 
any publication, frequntly more than is ob- 
. tainable from the letter press of the liter- 
ary portion. Read the advs. by all means. 

Leaving the editor to work up something 
equally good for the June Summary, let us 
glance through the following pages. The 
leading articles are all good. Dr. J. R. 
Etter treats of the application of electricity 
in plain, everyday language, and gives us 
promise of some very good reading in the 
scries of articles upon this subject, which 
will follow from month to month. Pelvic 
infection, its diagnosis and treatment, are 



well treated by Perisho, and his article 
should have the careful attention of every 
Summary reader. We frequently fail to 
realize that old age presents certain peculi- 
arities which should be given particular at- 
tention in our handling of cases occurring 
at this time of life, and Wolfe has brought 
this rather forcibly to our mind, in a short 
and to the point article, which we will all 
find, of vast value. None of us care to nm 
into any cases of placenta previa, but if we 
do we should remember what Hard has had 
to say upon the subject, as he has given us 
the items of interest in a nutshell, without 
any waste of words. Who would have 
thought of 'salting the baby" had not 
Evans called attention to the importance 
thereof. The baby is as much entitled to 
his **lick" as is the young deer, or calf, and 
perhaps the "salting" will save father many 
of his nightly promenades. Who knows? 
Try and see. Evans' remarks on calomel 
are particularly good. Tom A. Williams 
never wrote anything that was worthless, 
and while he only devotes a couple of col- 
un»ns to hysteria, you should not pass it 
by, because of the seeming brevity of his 
paper. It is good, every word of it. Red- 
field, who knows drugs, and how and where 
to use them, promises us much of value in 
his series, the introductory article of which 
is in the May Summary. Don't, for good- 
ness' sake, miss a single one of these pa- 
pers, as it will be your loss, not his, if you 
do. Our old friend Field gives the young 
man a lot of valuable information, as is 
always the case in every one of his articles. 
He says that there is no specific for any 
disease, and he tells the truth, but had he 
added that there was a specific for every 
indication, he would have covered the 
ground more thoroughly, as we, who have 
made a study of internal medicine, have 
found such to be the fact, in a vast major- 
ity of instances. He is right when he tells 
the young fellow not to use too many 
remedies; that a few well-learned will do 
all the work required. "The Fly" should 
have more attention, and we are pleased 
to see that DeArmand has again introduced 
him to us, and we hope that both he and 
others will continue both in "swatting the 
fly" and the source of his existence. We 
need a lot of information relative to this 



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THE MEDICAL SUMMARY 



subject. Marrs "swats the quack"' nicely, 
and in view of the Owen Bill, now pending 
before Congress, his remarks are very 
apropos. We should all get in line and not 
only "swat the quack" but the patent-medi- 
cine man and his League of Medical Free- 
dom. The poor dupes, the Christian scien- 
tists, while interfering with the possible 
passage of the Owen Bill, should not be 
"swatted" too hard, just hard enough to 
make them realize that they are acting in 
the capacity of the cat, and being used to 
pull the chestnuts out of the fire. It is too 
bad, in this area of education, that we find 
so many, seemingly well-read people, fol- 
lowing in the footsteps of the late lamented 
Eddy. But, as Marrs remarks, Eddy ism 
and all the other isms are of short life, as 
those who follow such fantasies are never 
satisfied with one cult for any great length 
of time, and finally find themselves drifting 
back to the scientific practitioner of medi- 
cine. 

In "Medical Gleanings," as is usually the 
case, we find that the editor has picked out 
some good little things. This department is 
not one to pass over with but slight atten- 
tion, as it frequently embodies a lot of 
"good things," which are of value to all of 
us, no matter how much we may think we 
know. The editor shows in this departinent 
that he cons all of the journals with care, 
and we are glad that he does, as it helps us 
out of many a hole. 

"Notes and Queries" give us many things 
to think about, and we are not justified in 
missing a single thing appearing in these 
latter pages of every number of the Sum- 
mary. Brady, when he tells us that we 
really catch coryza, is absolutely truthful. 
It may not be through sitting in a draft, as 
we used to think, but through the entan- 
glement of micro-organisms within our 
breathing apparatus. Hammond, in treat- 
ing of the effect of cold upon dermatitis, 
gives us some very good hints, and we hope 
that we have not heard the last from him 
relative to skin diseases. We know but lit- 
tle about diseases of this class, as general 
practitioners, and anything on the subject 
is always valuable. Again we run into our 
old friend Field and his remarks regarding 
ethics, and later, the tongue. In both of 
these communications he has expressed 



great truths in few words. How many of 
us are there who have not "bumped up 
against" the sort of doctors he mentions in 
treating of ethics ? Too bad we cannot fol- 
low the precept of our legal brothers and 
disbar such gentlemen because of ungentle- 
manly and unprofessional conduct A few 
examples of such sort would work wonders 
in making this class of doctors "be good." 
His advice about "talking too much" is par* 
ticularly good. Let the doctor's acts, rath- 
er than his words, make his success. The 
man who expounds upon the street and in 
public places regarding his own personal 
greatness, not infrequently is to be found 
lacking in more ways than one. Let your 
work talk, not your tongue. But don't be a 
ninny, if anyone asks your opinion on* any 
subject connected with medicine. Make 
your remarks general and not personal. 
Again we find that Field has a few remarks 
on medical journals, and I am sure that 
every Summary reader agrees with him 
most heartily. "They are all good, but 
some are better than others," particularly 
the Summary. The remarks on typhoid 
fever by both Neal and Cooper are good. 
This subject is one which can never be 
threshed out to an end, and every paper 
published relative to the subject carries 
something of interest to every internist 
The different writers may not agree, but 
they all have something good to offer, and 
we should not overlook a single thing on 
this subject. Harman, in his few remarks 
regarding mastitis, gives us some pointers 
of great interest, and this is another com- 
munication which should be given "prayer- 
ful and careful attention." Davis asks 
some questions regarding a peculiar skin 
trouble which should evoke numerous re- 
plies, and we trust that they will be forth- 
coming. If we had seen any cases of ^is 
sort in our part of the country we would 
surely tell what we had done with them, 
but out here in the mountains about the 
only skin trouble we have is too much "tan" 
and too many "freckles," which have a ten- 
dency to worry the fair sex. Lake is abso- 
lutely right in his remarks regarding our 
extra-professional duty. No doctor should 
be a doctor all the while. Let him forget 
that he knows anything of "pills or pow- 
ders" for at least a portion of the day and 



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139 



be just a simple "good fellow." The doc- 
tor who cannot refrain from "talking shop" 
on every possible occasion, "makes me 
tired" with an exceeding weariness. Every 
man should be a child at times, and the 
doctor who gets out and romps with the 
"kiddies," his own or those of the neigh- 
bor, not only pleases the youngsters, but 
increases his red blood count. Banes has 
given us some new ideas in the use of 
apomorphine. Let us try them in selected 
cases and report our findings in the Sum- 
mary. If we were to pass by those little 
'*squibs" which the editor puts in to fill out 
the ends of columns, we would be doing 
him an injustice. Like the "Gleanings," 
they show us that the gentleman who sums 
for the Summary is "on the job" every 
minute, and that he is not going to let us 
miss any of the good things of the medical 
life, through any oversight upon his part. 

The "Summary Gleanings" are always 
good, as is the meat of the sound nut. Just 
a few words, but they frequently speak 
volumes, and we should never pass them 
by, simply because of their brevity. 

The Summary is one of the journals 
which has done much to pull the profession 
out of the state of therapeutic nihilism, 
through the publication of the findings of 
its contributors, relative to the application 
01 drugs, in the treatment of disease. While 
the editor may not agree, in toto, with all 
the ideas expounded, I am sure that he has 
never refused space to a single contributor, 
if his views were within reason.' He has 
not shown any narrow-mindedness in his 
acceptance of contributions, as all of the 
various schools of medicine have had the 
benefit of space within the pages of the 
Summary, thus making us all much broad- 
er doctors, regardless of any possible sec- 
tarian leaning, as regards any particular 
school of medicine. We might say that 
every succeeding number of the Summary 
was better than the one before, but I do not 
believe that this would be an absolute truth, 
a.s every issue of the Summary is so full of 
good things as to make it questionable 
which particular one is the best. Every 
number is practical and that is what proves 
of value to the busy practitioner, who has 
not the time to devote to the fads and fan- 
cies with which we find so many of the 



joqrnals filled at present. Brother Andrews 
sticks closely to medicine, and we are glad 
that he does, as we can get plenty of dis- 
cussions on social subjects in other than the 
medical journals, and oh, how tired we are 
getting of such subjects within the pages 
of journals which should lead us within 
better lines of practice and application of 
those agents with which we combat disease. 
Gardnerville, Nevada. 



NATURE'S '<SWE£T RESTORER.'' 

By D. L. Field, M.D. 

The duties of life can be nearest per- 
formed when one is at the top of physical 
condition. If we habitually pass from nin^ 
or ten o'clock at night, and don't seek cur 
rest abed before 12 o'clock midnight or i 
o'clock A. M., we must pay the penalty of 
violated physiological law, by enfeebling 
both mind and body sooner or later. Such 
dissipation begins to show its eflFects in a 
quicker pulse and an excitability of the 
cerebral and nervous system. Sufficient 
rest and sleep will check the ebbing tide of 
life. While it is a physiological fact, our 
vital powers gradually recede as the even- 
ing hours approach, it is therefore inevit- 
able if we still further tax such powers un- 
reasonably we are sure to become weaken- 
ed physically and mentally. Our nerves 
are overstrained, our arterial circulation 
accelerated, and our nervous system be- 
comes clamorous of rest and refreshment. 
Those who keep late hours are always at 
low water mark. They are sure to become 
victims of nervous diseases. 

How many sit up till a very late hour 
and add to the loss of sleep of loading their 
stomachs with a "dutch supper," or oysters, 
eggs and ice cream, finally winding up with 
stimulants. Why? Because they feel the 
flagging nervous and physical powers, and 
resort to the worst form of dissipation to 
break down their constitutions and superin- 
duce disease. This sort of habit is becom- 
ing alarmingly prevalent, and broken down 
nervous systems and premature physical de- 
cline are manifest on every hand. In fact, 
such loss of rest and sleep bring on an 



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THE MEDICAL SUMMARY 



evening febrile state. It is easy to see how 
over-fatigue and over-indulgence in these 
late-hour habits should bring a feverish 
state. The late hours, excesses and mental 
worry of our public men causes many of 
them to suffer nervous collapse, and if any 
one of them is stricken with a severe ill- 
ness, it is the rule that they die, most of 
them when they have not gone far beyond 
sixty years of age. They unfit themselves 
by their habits to withstand disease. Not 
only do they lose needed sleep, but are 
guilty of excessive gustatory indulgence at 
the very hours when they should be pro- 
foundly asleep. Insomnia is the ruin of 
public men, as their strenuous life and men- 
tal tax precludes the possibility in most 
cases of getting sleep even when they have 
"drawn the drapery of their couches about 
them." 

Premature breakdown is the rule of 
statesmen. Some of such men live on to a 
greater age. but it is a surprise to physiolo- 
gists that they do so. Generally, if they 
live to three score and ten they are simply 
wrecks. How many can say: 

I love to wake at early dawn, 

When sparrows "cheep," 
And then turn over, with a yawn, 

And go to sleep! 
In fact, I love the sweet embrace 

Of slumber deep. 
And heaven to me will be a place 
Where I can sleep! 
Another : 
Tis beautiful to leave the world awhile, 
For the soft visions of the gentle night, 
And free, at last, from mortal care or guile, 
To live as only in the angels* sight. 

Sancho Panza said: "God bless the man 
who first invented sleep." 
Jeffersonville, Ind. 



Small and frequent pulse with a hot and 
dry skin are indications for the usefulness 
of the administration of aconite. 



The hot flashes that are so frequently 
met with during the establishment of men- 
opause may be relieved in a great degree 
by small doses of pulverized camphor, say 
from one- fourth to one grain three or four 
times a day. 



SOME SUMMER REMEDIES AND THEIR 
INDICATIONS. 



By H. Hamilton Redfield, A.B., M.D. 

Profeasor of Therapeutics in The Bennett Medical College, 
Medical Department of The I^ola Univerilty, 
Chiea^, IlL Chief Therapeutist to The Jef- 
ferson Park Hofliptal, Chicago, IIL 



Veratrine. — The official alkaloid of ver- 
atrum sabadilla (cevadilla), a bulbous plant 
belonging to the natural order of liliacex, 
and indigenous to Mexico and Central 
America. In addition to veratrine, this 
plant also contains the alkaloids cevadil- 
line, sabadine, sabadinine, and a base which 
is known as Wright's veratrine. Dose of 
the standard granule, 1/134 grain. 

Physiological Action. — In its physio- 
logic action veratrine closely simulates the 
action of aconitine, it being an exceedingly 
powerful depressor of the cardiac appar- 
atus in maximum doses, as well as a spinal 
paralyzer. Its effects upon the respiration 
are not near so marked as is that of aconi- 
tine, and it also differs from that drug in 
being an emetocathartic paralyzing all the 
motor system centrally, impairing all re- 
flexes, but leaving sensation unimpaired. 
It possesses little if any action as a diuretic 
or diaphoretic, so far as any direct stimula- 
tion of these excretions is concerned, but 
by relaxing the vessels it opens the doors 
of exophthalmic goiter, when the action of 
own escape and that of all other hemic 
toxins. 

While the exhibdtion of veratrine in 
large or excessive doses is productive of 
marked depression, yet its use is not fraught 
with any great degree of danger, as it is 
seldom fatal, producing free purging and 
vomiting before the excessive depression is 
manifested. When death does result from 
the exhibition of veratrine, it is from par- 
alysis of the heart. 

Given in small doses, veratrine produces 
a diminution in force of the heart, but docs 
not at first have any appreciable effect up- 
on the rate of the pulse. Small doses relax 
the tension of the arterioles, thus relieving 
the heart of part of its work. By this the 
circulation is facilitated and the nutrition 
of the heart muscle and and other tissue is 
enhanced. 



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Its continued exhibition in full doses, 
however, has the effect of causing a de- 
crease in the rate of the pulse which be- 
comes soft, compressible, and with a mark- 
ed tnedency to rise upon the slightest effort 
or exertion on the part of the patient. 
Muscular weakness becomes marked, and 
nausea and vomiting occur. 

Given in large doses, the foregoing symp- 
toms are all increased, the pulse becomes 
exceedingly rapid, and is so weak as to be 
hardly appreciable to the finger. The skin 
becomes cold and clammy, and debility is 
extreme. Vomiting is constant,, the patient 
becomes dizzy, there is impairment of the 
vision, and partial unconsciousness results. 
While it has been found that aconitine 
and veratrine closely resemble each other 
in their action, yet it should not be taken 
for granted that the one can replace the 
other or that veratrine can be placed in the 
same category with aconitine as a febri- 
fuge. While veratrine possesses a powcr- 
fol effect upon the heart, the same as does 
aconitine, yet it lacks the power as an 
equalizer of the circulation, a quality pos- 
sessed to a marked degree by aconitine, 
which latter by its influence over the vaso- 
motor system becomes the antipyretic, par 
excellence. 

The most suitable sphere of action of 
veratrine in the acute inflammatory condi- 
tions, seems to be as an arterial and cardiac 
sedative, in which role it justifies its ex- 
hibition and gives excellent results. 

Therapeutics. — From the foregoing it 
would follow, a priori, that veratrine would 
be the indicated remedy whenever the pulse 
is full, strong and bounding, showing great 
arterial tension, excitement or congestion, 
sometimes coupled with nausea, vomiting, 
and profuse perspiration. 

It should not be forgotten in aneurism, 
when its depressing action on the circula- 
tion is desired. 

In cerebral congestions, when the patient 
complains of a bursting sensation in the 
bead, the cause of these congestions often 
being traceable to heat, alcohol, vascular 
irritation, or a condition of plethora, vera- 
trine is of the greatest service. 

In the initiatory stages of cerebrospinal 
fever, when the onset is sudden, the con- 
gestion intense, pulse hard, full and bound- 



ing, with nausea and vomiting, veratrine 
should be the remedy of choice. 

Fordyce Barker gives it the first place in 
puerperal fever due to metritis. 

It is most effective in the congestive 
stage of pneumonia, when the pulse indica- 
tions are the ones so typical of the use of 
veratrine, hard, full and bounding, with 
respiration rapid, and the patient is bathed 
in a copious perspiration. 

It should be studied in all acute conges- 
tions of the lungs, which are sometimes 
met with in acute bronchitis and asthma. 
In these cases the fever is high, dyspnea 
extreme, and the pulse is the typical vera- 
trine-pulse. 

Diseases of the heart, such as endocardi- 
tis and pericarditis when the arterial ten- 
siqn is high, are benefited by veratrine. 

Distress in the cardiac region, with an 
increased heart action and a full tension 
pulse call for veratrine. 

In peritonitis, metritis, ovaritis, with a 
high-tension pulse, and the temperature 
running high; also in the convulsions of 
the puerperal state, when the face is flush- 
ed, and the blood vessels of the head and 
neck are extremely congested, it is the 
remedy of choice. 

In nephritis, hepatitis, cystitis, pleurisy 
and tonsilitis, when the arterial tension is 
high and the congestion marked, veratrine 
should be studied, as it will give results 
that are all that can be desired. 

It is a very serviceable remedy in cases 
of exophthalmic goiter, when the action of 
the heart is strong and the arterial system 
under great tension, as is usual in the early 
stages. 

The action of veratrine as a reducer of 
arterial tension makes its indications ex- 
ceedingly patent, and it should be exhib- 
ited in all cases where there is a condition 
of excitement or congestion of the heart, 
with a full, strong pulse. 

Given together with aconitine and digi- 
talin, it makes a combination unexcelled in 
the treatment of the acute inflammatory 
conditions when the pulse indications for 
veratrine are present. These conditions 
are seen at the outset of the asthenic fevers, 
and in these cases the exhibition of aconi- 
tine, gr. 1/134, digfitalin, gr. 1/67, and vera- 
trine, gr. 1/134, will bring about an altera- 



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tion in the condition quicker and more plea- 
santly than any other combination that can 
possibly be devised. 

In the asthenic fevers when the opposite 
pulse condition exists — soft, slow and com- 
pressible — the exclusion of veratrine from 
the above combination and its replacment 
with strychnine arsenate will prove equally 
effective to meet the condition. 

In the dread condition, eclampsia, the 
bete noir of all obstetricians, the exhibition 
of veratrine has been productive of the best 
results, and many lives have been saved by 
its use. It is best given hypodermically, 
and should be repeated at short intervals. 
In these cases veratrine is best given as 
follows: Dissolve six granules in a fluid 
dram of water and inject. Repeat the dose 
in fifteen minutes; and continue to full 
physiological effect. 

The more veratrine is studied, the more 
it is appreciated, and once its power over 
the circulation is realized and understood, 
it becomes a sheet-anchor to the physician 
in meeting the conditions so often found in 
the onset of the acute inflammatory condi- 
tions. 

Emetine. — Emetine is the principal al- 
kaloid found in ipecacuanha (common name 
ipecac), a Brazillian shrub of the natural 
order of rubiaceae, and containing in addi- 
tion to emetine, the alkaloid cephaeline, and 
the glucoside ipecacuanhic acid. Dose of 
the standard granule, 1/67 to 1/6 grain. 

Physiological Action. — Emetine is an 
expectorant, cholagogue, diaphoretic, hemo- 
static and antidysenteric. 

Taken internally, it irritates the mucous 
membrane of the stomach, and the termina- 
tions of the vagus nerve, with the produc- 
tion of emesis. 

The secretions of the bronchial mucous 
membranes are increased, and in small 
doses it acts as a hepatic stimulant, while 
in large doses it has the action of a chola- 
gogue cathartic. By some observers it is 
said that the injection of emetine into the 
blood stream has a dissolving effect upon 
the red corpuscles. 

The principal use made of ipecac or its 
principal alkaloid emetine, theretofore has 
been in the role of an emetic, it being abso- 
lutely safe, having no depressing effects 
though acting somewhat slowly. 



Therapeutics. — Emetine should be stud- 
ied in bilious headaches resulting from diet- 
ary indiscretions. The action to be desired 
in these cases is that of emptying the over- 
loaded stomach, a function performed by 
emetine in a very satisfactory manner. 
However, if prompt emesis is desired, apo- 
morphine is to be given preference. 

By some authorities emetine is advised at 
the onset of the eruptive fevers, but those 
of the active-principle "family" who arc 
aware of the potency of the defcrvesccnt 
compound and the dosimetric trinity, to- 
gether with 'the intestinal antiseptics, saline 
laxative and calcium sulphide, will take 
issue with these exponents of an "ipecac 
vomit" in the early stages of those diseases. 
The "clean-up, clean-out, keep-clean" sys- 
tem will give better results than can ever 
be obtained by emetine for inducing emesis. 

In dysentery the exhibition of emetine 
with copper arsenite, in connection with 
rectal flushings with silver nitrate, is the 
best system of treatment. If there is a de- 
cided susceptibility to the influence of eme- 
tine on the part of the patient, give the 
granules dry on the tongue, and have him 
lie flat on the back for half an hour after 
each dose. ' 

In catarrhal jaundice when the seat of 
the trouble is in the bile-ducts, emetine 
should be exhibited with chelidonin, jug- 
landin, collinsonin or chionanthin in ac- 
cordance with the indications. It lessens 
the viscidity of the mucus, which has been 
occluding the ducts. 

It should be studied in cases which show 
a marked and persistent nausea, where the 
tongue is clean or only slightly coated, sali- 
vation and emesis are present, the latter 
affording no relief. This condition of con- 
stant nausea and vomiting which is pro- 
ductive of no relief is often met with in 
cases of chronic catarrh of the stomach, 
gastric indigestion, and other stomach de- 
rangements arising out of improper indul- 
gence in rich foods, pastry, confectionery, 
ice cream and other delicacies. 

Emetine is of great service in the vomit- 
ing of alcoholism, also in some cases of the 
vomiting of pregnancy. 

These patients, as a rule, show a tongue 
slightly coated if at all, face pale, mucous 
membranes of the mouth moist, some sali- 



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vation, and complain of a feeling as though 
the stomach were sagging down all the 
time. 

It should be remembered in enterocolitis 
or any catarrhal condition of the intestional 
tract, and in all cases of green watery 
stools, the slimy dysenteric stools, or those 
which have the appearance of fermented 
yeast 

Emetine proves its sterling worth at the 
onset of those diseases of childhood inci- 
dent to the second summer and which fill 
the heart of the anxious mother with an- 
guish and despair. In the majority of these 
cases a history of improper diet will be 
elicited. The little patient is emaciated, 
face hollow and expressionless, lips are 
blue, skin is cold and clammy, dark circles 
are seen under the eyes, the fontanelles arc 
depressed, there is muscular twitching dur- 
ing sleep, and the child lies prostrate in a 
comatose condition : the stools are thin and 
watery and contain quantities of slimy 
green material, while the odor is musty and 
stale. 

In cholera morbus, when the characteris- 
tic cutting pains which run from right to 
left across the belly, but are worse in the 
region of the umbilicus, are present, eme- 
tine has been a life-saver in many instances. 

It should be remembered in the dysentery 
which appears in the autumn when hot days 
are followed by cool nights. 

It is useful in bronchitis and other dis- 
eases of the respiratory tract during the 
irritative and inflammatory stages, when 
there is an increase of the secretions. The 
attack usually commences with sneezing, 
dry cough, spasmodic in nature, dyspnea 
and an asthmatic type of constriction. The 
patient has great difficulty in breathing, 
and wheezes and coughs, the cough termi- 
nating in a profuse expectoration of mucus. . 

It has given good results in pertussis 
when exhibited during the catarrhal period. 
The child cannot get its breath, the face is 
Hvid, the limbs are rigid, and there is 
strangling, gagging, epistaxis and vomiting. 

In hemorrhage of any description, either 
the passive or active, when the blood is 
bright-red, and there is constant nausea, 
emetine should be given a trial. 

It is the remedy of choice in headache 
when the patient complains of a feeling as 



though the bones of the head were bruised. 
There is a pain extending from the tip 
down to the root of the tongue, and the 
pain in the head is usually unilateral; the 
face is pale, corners of the mouth arc 
drawn, blue rings are about the eyes, and 
the nausea is extreme and constant. 

In those cases of intermittent fever 
where the patient has taken quantities of 
quinine, the fever is intense and the chill 
moderate, while the nausea and vomiting 
are constant, and prostrating, emetine 
proves effective. 

622 W. 71st St., Chicago, 111, 

(To be contiDued.) 



HEREDITY A POTENT FACTOR IN PATH- 
OLOGIC CONDITIONS. 

By W. M. Alter, M.D. 

Amidst the rapidly changing theories of 
the last half century, it is gratifying to 
note that one scientific fact is becoming 
obvious to the minds of most observers, 
and that is the fact of heredity. As a po- 
tent and you might say almost inexorable 
factor in a large per cent, of pathologic 
conditions, we at present cannot estimate 
the per cent, of the different diseases to 
which this dreadful fiat lends its fatal 
blight, until further observation enlightens 
us more clearly in regard to this dark 
enigma; but among the many things we 
have learned which is not true, we have 
alj-o learned enough of facts which throws 
a solemn responsibility on us in regard to 
protecting the anti-natal generation from 
being handicapped with predisposition to 
fiisease, and I will say, also to crime; for 
it is through the channels of generation 
that criminal proclivities are transmitted to 
unborn generations. 

I have for some years back called atten- 
tion to these facts through the press, and 
am very much gratified to see even some 
ministers of Christ pointing out these 
truths. 

Now, taking this view of this momentous 
subject, look at our responsibilities. 

While the proper treatment of this is 
medico-political and should receive the at- 



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tention of all sound statesmen through 
which this prophylactic measure must be 
promoted through the proper regulation of 
marriage relation, I conceive it to be the 
duty of medical men to instruct the people 
in this important pari 

Not in the manner sought by the "Owen's 
bill," nor the "Arkansas State board of 
health bill," which was stolen before it re- 
ceived the seal of legitimacy. No, I regard 
such legislation as tyranous and calculated 
to retard the true advance of medical 
science. 

The people have the right to the benefit 
of applied science along the lines I have 
mentioned, and these facts should be 
brought well into the range of the ordinary 
comprehension, as a matter of education, 
so that the aspirant for nuptial joys may 
be able to intelligently remove all deliteri- 
ous conditions from the channels of gener- 
ation, through which his progeny is to en- 
ter the stage of human action. 

While the method I suggest here as a 
preventive of disease and crime, need not 
stop our effort to ameliorate the condition 
of the afflicted and prevent as far as pos- 
sible adverse surrounding conditions from 
calling into activity hereditary criminal and 
disease tendencies. This, of course, would 
require the development of a proper politi- 
co-economic system under which could be 
allowed the proper wants of normal hu- 
manity. This would soon obliterate crime 
and disease, and man would finally be able 
to obey the command of Jesus Christ, enun- 
ciated in what we call the "golden rule," 
and thus live in harmony with God's holy 
law, which embraces the great laws of na- 
ture, which governs our racial destiny. 

Reader, do not think that I wish the pro- 
fession should stop using the means placed 
here by our God to use as medicine in heal- 
ing the sick, and mitigating the sufferings 
of the afflicted. No, we should seek out 
all the means He has provided and develop 
the science of healing to the greatest extent 
of our power, seeking revelations of na- 
ture's secret through proper scientific meth- 
ods. 

This course in conjunction with the anti- 
natal treatment I have mentioned above 
will in a generation or two bring grand 
results to our race. 



I believe it is a duty we owe to our 
Creator, to our race, and especially to the 
present period to direct the activity of the 
great reform movements in human affairs 
to the proper discrimination to knowledge 
along the line I have imperfectly discussed 
in this article. 

By doing this we may keep these who 
wish for selfish motives under the cover 
of ambiguous verbiage from using the peo- 
ple and their servants to place them in the 
power of a medical tyranny. 

Yours for the promotion of the true 
medical science. 

England, Arkansas. 



OPTIMISM CONCERNING THE EXISTENCE 
OF BEDBUGS, AND PESSIMISM CON- 
CERNING DARK BEDROOMS 
AND CARPETS. 

By A. Rose, M.D. 

Leibnitz in his Theodicee demonstrated 
that this world is the best world, notwith- 
standing apparent imperfections the whole 
is perfection. Baumeister has written a 
historia doctrinae de Optimo mundo; Kant 
has shown the failure of all philosophical 
attempts in the Theodicee; Voltaire in his 
Candide ou I' optimism has ridiculed the 
doctrine of optimism with grotesque sar- 
casm. Anthony. Comstock, if he has not 
done so, will place this book on the index 
librorum prohibitorum; and Schopenhauer 
has founded a system of pessimism. The 
history of philosophy reminds us of a grave 
yard where every philosopher has written 
on the tombstone of his predecessor hk 
jacet stultus! We medicine men have the 
principle de mortuis nil nisi bene, therefore 
I have no fear when I speak in favor of the 
existence of bedbugs. 

In a German city there lived a widow 
who supported herself by letting lodgings. 
A young mechanic rented a furnished room 
from her, lived in it for a time, became 
sick with pulmonary phthisis and died from 
this disease. A second young man then 
occupied the same room, and likewise con- 
tracted, and died from, consumption. And 
so it happened with a third occupant of the 



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fatal room. A physician who attended the 
last of these three persons, on hearing of 
the preceding cases, examined the room, 
and found it infested with bedbugs. He 
made a microscopic examination of these 
vermin and found they were carriers of the 
tubercle bacillus. 

We read much about the fly as a carrier 
of disease germs ,but very little is heard of 
the bedbug as a dangerous insect For the 
presence of this syntrophos, as well as of 
another companion, the bus, there must be 
a raison <fetre. It indicates unsanitary con- 
ditions, and the extermination of these in- 
sects is a most important matter, and from 
the optimistic point of view we may con- 
sider the presence of bedbugs as a blessing 
when it induces people to observe more 
cleanliness. And a greater blessing it 
would be if the board of health instead of 
confining itself to the routine disinfection 
in cases of contagious diseases in general, 
would insist on the extermination of bed- 
bugs and thus secure cleanliness, the first 
condition of health. The ordinary general 
disinfection will not affect the bedbugs. 

There exists a great industry to raise 
millions of dollars for the purpose of ex- 
terminating phymatiasis (barbarously call- 
ed by the hybrid name tuberculosis), and 
there are congresses in Washington and in 
Rome to treat on this question. The lit- 
erature on the subject is so immense and 
ail what we have learned is that we cannot 
protect ourselves against invasion of tuber- 
cle bacilli, nor, what is more important, 
against development of phymatiasis, after 
such invasion, in case we are subject to 
predisposition. * 

The treatment of phymatiasis remains 
as it was before the period of bacteriology 
in medicine, namely, in changing the nutri- 
tive soil, in invigorating the constitution, in 
order to develop power of resistance until 
the bacilli have been eliminated. The re- 
sults obtained under favorable conditions, 
as for instance in proper institutions, which 
we may call therapeuteria or iatreia instead 
of sanatoria or sanitaria, are by no means 
80 satisfactory that we have no need to look 
for still better and additional methods as 
long as we have not found the curative 
serum and as long as we are unable to se- 
cure accommodation for the majority of 



sufferers from phymatiasis in proper iatreia 
or therapeuteria. 

In different medical journals at different 
occasions I have spoken of two remarkable 
English-American institutions which favor 
the development of phthisis, and if Leib- 
nitz had known them he would not have 
said that everything in this world is for 
the best; I mean the dark bedroom and 
the carpet nailed on the floor. The public 
should be educated to abhor both these 
evils as well as that living in the basement 
How can the hopes, the promises of exter- 
minating phthisis be fulfilled as long as the 
carpet is nailed to the floor, thus prevent- 
ing cleanliness and affording a fortress in 
which germ-conveying insects can impreg- 
nably entrench themselves, so long as mil- 
lions of poor devils are deprived of light 
and air in their dark bedrooms ; so long as 
bedbugs, lice and other germ carriers are 
not exterminated as well as flies? Let me 
emphasize the dark room question: The 
exclusion of light, pure air and sunshine 
from living apartments, especially in build- 
ings facing on narrow streets, means in- 
ception and prevalence of disease among 
the tenants, increasing progressively with 
the age of the building. How luxuriantly 
must phthisis, the bedroom disease, flourish 
in such congenial environment! 

Dr. A. Suderum, the expert sanitary of- 
ficer and statistician, came to America 
about a year ago; during his brief stay 
among us he compared housing conditions 
in German cities with those in the United 
States, and found that Germany has ad- 
vantages over us by reason of the greater 
power of her public opinion, that there are 
things customary in America which would 
not be tolerated in Germany. 

One night I was called to a town in West- 
chester county of 5,000 inhabitants. I had 
missed the last train and asked a watch- 
man to bring me to a hotel. He not only 
brought me to a hostelry but even gave me 
a room without having disturbed anybody 
in the house. This room had no window, 
and for the first time in my life I had to 
sleep in a dark bedroom. Remarkable 
seemed to me the circumstance that the 
building stood on a large square. I could 
not recollect having ever seen or heard of 
a dark bedroom in Germany, and now, af- 



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ter having spoken so much against them in 
this country, I investigated the matter. 

Reichs Archiv-Rat Dr. Striedinger, of 
Mimich, had the extreme kindness to send 
me the following informations, together 
with a volume containing the building laws 
for Munich. A uniform building law foi 
all parts of Germany does not exist; how- 
ever, such a uniform law does not appear 
desirable on account of the different con- 
ditions in different sections of the empire 
due to climate, building materials and his- 
tory. It is not even required that a federal 
law (Reichsgesetz) should establish the 
sanitary demands in regard to the limit of 
what is to be observed in building, because 
there exists no part in all Germany in 
which not such a minimum of absolutely 
necessary precaution is not already de- 
manded by law, and there is no fear triat 
such demands should be reduced anywhere. 
Throughout Germany it is indispensiblc that 
dwelling rooms and sleeping rooms must 
have at least one window which leads in 
the free open air. To prc(ve this. Dr. Stried- 
inger writes: "I should have to send the 
thousand different official books giving the 
building laws of the different states, prov- 
inces, precincts, cities and towns. This be- 
ing impossible, I confine myself to mail to 
your address the building laws of Munich. 
Permit me to say that these laws are the 
best, based on the most modem principles, 
and at the same time the strictest of any. 
In most other large cities the ordinations 
are somewhat milder, but the difference is 
insignificant, and in the principles there is 
uniformity.'' 

I beg to quote now from the Muenchner 
Bauordnung, published in 191 1: "All rooms 
to be inhabited or occupied, by persons, 
such as dwelling and sleeping room=, work 
shops, kitchens and water-closets, as well 
as staircases, stables and wash kitchens, 
must have at least one window, of sufficient 
size and of suitable situation, which leads 
in the free open air. Rooms destined to be 
occupied by a larger number of persons or 
in which a greater contamination of air 
takes place, must have special arrange- 
ments to secure sufficient change of air." 

Whatever the misery in the overcrowded 
dwellings of the poor working classes in 
the large German cities may be — and it is 



perhaps greater than the misery in the 
quarters of the same classes in large Amer- 
ican cities — one fact is positive : There are 
no dark bedrooms in Germany! 
173 Lexington Ave., New York City. 



REMEDIES FOR HYPODERMIC USB. 



By J. A. Burnett, M.D. 



Melilotus alba with equal amount of 
water can be injected hypodermically in 
trifacial neuralgia and will give quick re- 
sults. It does not have to be injected into 
the nerve, but in the vicinity of it. One 
writer states that it is generally believed 
that there is little or no difference in the 
therapeutic action of melilotus alba and 
melilotus officianalis. It is said that if one 
has a headache pain in the chest, stomach 
or anywhere else, that yellow melilot vill 
relieve it in five minutes. This applies to 
the internal use of the mother tincture. 
Likely the hypodermic use would be of 
still more value. The homeopaths use yel- 
low melilot in nose bleeding, congestion, 
furious neuralgia, headache, hemorrhage, 
mania, delirium tremens, etc. It is a rem- 
edy that deserves further investigation, 
especially its hypodermic use in painful 
conditions. 

Achillea millefolium has been used h3rpo- 
dermically with good results in menorrhagia 
of passive character in urinary suppression, 
from capillary obstruction, and in chronic 
leucorrhea. Dr. Frank Webb reports a 
case of menorrhagia that had resisted the 
internal use of several well-known drugs, 
including the internal use of achillea, that 
was relieved by two hypodermics of achil- 
lea given one hour apart. When he gave 
the second injection the flow was greatly 
reduced, and the next day it had entirely 
ceased. Dr. Webb prefers Boericke and 
Runyon's aqueous achillea in preference to 
all others for hypodermic use, as it is pain- 
less. He usually begins with one dram and 
then uses 30 drops every four to six hours 
for two or three doses. He injects it into 
the thigh. He says it never fails. In one 
case of urinary suppression in an old man 
who was in a state of coma, two injections 



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of 30 drops each of achillea was injected 
hypodermically half an hour apart, and in 
less than an hour his kidneys began to act 
and his life was saved. 

I feel safe in saying that the hypodermic 
use of achillea would be of great value in 
cases of malarial hematuria when there is 
much blood from the urinary organs. The 
above experience with the hypodermic use 
of achillea proves the value of hypodermic 
medication over all other modes of admin- 
istration. 

Serpentaria is a drug not so very well 
known. The therapeutic uses of aristo- 
lochia serpentaria is not very extensive. 
When there is marked torpidity of the skin, 
especially of the sudorific glands, at the 
onset of a fever or in any torpid condition 
of the circulation, the hypodermic use of 
serpentaria gives quick and permanent re- 
lief. 

Geranium maculatum is a good astrin- 
gent. The hypodermic use of geranium is 
good in dysentery in 15-drop doses once a 
day. It should be given when there is no 
fever or when the fever begins to fall. 
Likely it would be of great value in hem- 
orrhage in typhoid fever ; at least the hypo- 
dermic use deserves a trial in such cases. 
Geranium has been injected into hemor- 
rhoids of a venous nature and into nasal 
polypi, but must be used with great care in 
such cases. We need a hypodermic pre- 
paration of geranium. 

Thuja occidentalis is a useful remedy. 
Two or three injections of thuja into ven- 
ereal warts causes them to fall out and never 
return. It is of much value when injected 
into some variety of pile tumors. I do not 
know whether thuja has been injected into 
the circulation for systemic effect or not, 
but it is very useful when injected into 
various growths. 

Gelsemium sempervirens is a remedy that 
can be used hypodermically for the same 
purpose that it is given internally, but the 
hypodermic dose must be carefully regulat- 
ed or bad results may occur. It is a rem- 
edy that is not really suited for hypodermic 
use when it can be given by mouth. In 
other words, its hypodermic use has no ad- 
vantage over its internal use to any great 
extent that would make it a popular drug 
for hypodermic use, considering its toxic 



action; however, there seems to be quite a 
difference in opinion in regard to its toxic 
action. 

Phenol is a drug that has been used hy- 
podermically for many years, but still has 
not drifted into very general use. Bartho- 
low, in his book on "Hypodermic Medi- 
cation," gives the following formula for 
the hypodermic use of phenol: 

5^ Phenol c. p gr. x. 

Aqua dist $'}, 

M. From 15 drops to one dram can be 
injected. This causes a smarting which 
declines rapidly and is replaced by a local 
anesthesia and analgesia for some distance 
around the puncture. These injections have 
proved to be of value in erysipelas by in- 
jecting five drops just at the margin of the 
inflammation in several places two or three 
times a day. The injections have been 
made in cases of synovitis, white swelling, 
adenoma, bubo, fibroma, etc., with benefi- 
cial results. In ulcers resembling epithe- 
lioma this solution can be injected so that it 
will come in contact with the tissue imme- 
diately adjacent to the diseased tissue with 
good results. They are also of value in 
acute articular rheumatism when injected 
about the affected joint, and are of value 
in chronic rheumatism, myalgia, neuralgia, 
grip, etc. 

Phenol has been injected into boils be- 
fore the formation of pus to abort them. 
Equal parts of phenol and glycerin injected 
into pile tumors causes them to slough off. 
A pile clamp should be placed on them be- 
fore the injection. A weak solution of 
phenol can be injected into pile tumors, 
which causes them to shrivel up and dis- 
appear. Some consider the hypodermic use 
of phenol equal to diphtheritic antitoxin in 
many cases of diphtheria. The hypoder- 
mic use of phenol no doubt acts as a sys- 
temic antiseptic and is of some value in 
septic conditions. 

Notes on Hypodermic Medication. 

It is well known and generally admitted 
that the hypodermic mode of administering 
remedies is the most perfect mode of ap- 
plication known. 

When giving hypodermics, in many cases 
it is best to produce local anesthesia with 
an ethyl chloride spray before the needle 
is inserted, as many patients are afraid of 



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hypodermic injections. Again, much pain 
produces prejudice against hypodermic 
medication. As a rule it is always best to 
use the ethyl chloride spray when irritat- 
ing or painful drugs are used, such as nu- 
clein, alcoholic solutions and similar agents. 
Of course, all irritating and painful drugs 
should be avoided as much as possible, as 
they cause prejudice against this form of 
medication. But when conditions demand 
them a little pain produced by the hypoder- 
mic injection should not be considered. 

According to my opinion, the intervals 
between hypodermic injections should be 
made as far apart as possible, for several 
reasons. If given too frequently the pa- 
tient may become disgusted with the treat- 
ment and ask for some other mode of ad- 
ministration. If given very often it would 
require the aid of a nurse, which could not 
be obtained in many localities. If the in- 
jections, especially in chronic diseases, 
could be arranged so they could be made 
only once in 24 to 48 hours, the physician 
then could make them himself and it would 
be done in the right manner and most pa- 
tients would appreciate it much more. 

The laity need not become familiar with 
the hypodermic syringe, as this mode of 
application requires some skill and should 
be done in a correct manner or not done at 
all. Of course, there are some conditions, 
as in acute cases in which the injections 
must be frequently repeated, but as a rule 
in chronic cases they can be put out at 
longer intervals. It is a well-known fact 
that the action of many drugs when given 
by stomach are antidoted by the contents of 
the stomach either by physiological action 
or chemical reaction. 

There are various references in medical 
literature of the danger of a small amount 
of calomel being converted into a bichloride 
by an excess of acid in the stomach. 
Whether this is true or not most all physi- 
cians combine calomel with sodium bicar- 
bonate almost every time, and again any 
experienced physician knows that when the 
combination is made there is from some 
cause less salivation following the use of 
the combination than calomel alone. 

When iodine or the iodides are taken af- 
ter meals, when much starchy food has 
been eaten, a portion may be converted into 



an iodide of starch by chemical reaction. 
It is stated that hogs' lard is an antidote to 
nux vomica and its alkaloids. Potter men- 
tions this. If such is the case, what is the 
use of giving nux or its alkaloids to a pa- 
tient that is eating much hog meat or using 
lard in his food? These are only sample 
reasons ; others could be given, but this is 
sufficient to call attention to this over- 
looked topic. 

By hypodermic medication the chemical 
antidote can be avoided, which is one ad- 
vantage hypodermic medication has over 
the stomach route. Some remedies when 
injected hypodermically have a tendency to 
run out at the needle hole. In all such 
cases the puncture in the skin should be 
sealed with flexible collodion. I notice that 
most alcoholic solutions are inclined to leak 
out at the needle hole, and often when 
large quantities of fluid is injected it will 
in some cases leak out, especially if the 
patient gets in a position as to cause pres- 
sure in a way to force it out. When it gets 
started to leaking out it most always all 
comes out unless sealed up with flexible 
collodion or similar preparation. Most phy- 
sicians are entirely too careless with hypo- 
dermic needles. No needle should be used 
unless it is aseptic. Each time after a 
needle is used it should be sterilized. Dis- 
eases can be communicated by hypodermic 
needles which would be carelessness or ig- 
norance on the part of the physician. Some 
physicians are in the habit of holding the 
needle over a burning lamp or match until 
it is red hot in order to sterilize it. This 
will sterilize it, but it will ruin the needle, 
and cannot be recommended. A needle 
treated in this manner may break off in the 
patient, which would not add anything to 
the physician's reputation or elevate his 
estimation on hypodermic medication. A 
needle should be sterilized the same as any 
surgical instrument. 

Some solutions that are used hypodermi- 
cally are hard on needles and have a ten- 
dency to cause them to rust. We have 
special preparations now on the market for 
lubricating hypodermic syringes and need- 
les which will keep them aseptic as well as 
in good order. Some of these solutions 
can be injected without any harm. 

Marble City, Okla. 



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Mthmi ^kwrng^ 







GALLSTONE COLIC. 



MEDICAL CHIPS OF PRACTICAL VALUE. 



Dr. J. I. Cawley, of Spring Haven, Pa., 
says: Talking of gallstones reminds me of 
the fact that these formations may often be 
prevented by prescribing a liver invigora- 
tor. A liver which is performing its func- 
tion properly, accompanied with natural 
bowel movements, will seldom permit that 
decomposition of the bile and precipitation 
of the salts which result in the formation 
of concretions, so-called gallstones. "Gall- 
stone colic" may be accepted as good evi- 
dence of the presence 9t hepatic insufficien- 
cy, or the liver may be enlarged in all di- 
rections and abnormally full of blood. The 
condition is usually accompanied by a slight 
jaundice, and a faulty elimination from the 
system of nitrogenous waste matter. It is 
a rational procedure, therefore, to adminis- 
ter an alkaline eliminant, to stimulate the 
hepatic function and restore a clean canal 
in which the process of absorption takes 
place. I have found also that minute doses 
of calomel, say i/io grain, every hour until 
bile is discharged profusely is a great aid 
in keeping the duct clean. 



UMBDT FOR POISON-OAK OR POISON- 
IVY. 



A hot solution of potassium permangan- 
ate made strong enough to be quite dark, 
rubbed in so as to reach the poison in the 
vesicles, is effectual. If the skin is broken, 
the solution should be quite dilute, and may 
be applied by means of a compress. The 
stain may be removed by applying a solu- 
tion containing a mixture of oxalic acid 
and sodium hyposulphite, freshly made, say 
a tablespoonful each of oxalic and hypo- 
sulphite to a pint of water.— L«/e & Health. 



Will Marry Healthy Only. — It is stat- 
ed that two hundred clergymen in Chicago 
have approved of the suggestion of Dean 
Sumners that a health certificate as well as 
a marriage license be demanded from those 
desiring to marry, and have passed a reso- 
lution urging pastors throughout the coun- 
try to direct their energies toward influenc- 
ing public opinion to endorse the plan. 

Neosalvarsin. — The advantages of neo- 
salvarsin over salvarsin consist in its easier 
solubility and its absolutely neutral reac- 
tion; the patients stand it better, and it can 
therefore be given in larger doses; the re- 
sults are equally good; and, finally, it is 
better adapted for intramuscular injections. 
— N. Y, Medical Journal, 

How TO Use Echinacea. — Echinacea to 
be of service must be given in appreciable 
doses, and in that respect I think it differs 
from most other drugs. I use it either hy- 
podermatically or in the nonalcoholic fluid 
extract form. In typhoid I use two drams 
to four ounces of water, teaspoonful every 
hour, and have never yet seen a patient de- 
lirious where it was used. — Dr, Sink, of 
Smith field, O,, in C. Med, & Surg. Reporter. 

More Manhood in the Profession — 
that's the greatest need. If we could only 
cultivate more bigness of character, more 
respect for cleanness of living, more sense 
of individual responsibility as to the re- 
sults of our work, more respect for the 
konor and honesty of other men, we should 
save a lot of time now lost in jealousies, 
bickerings and hatred. Let us get together 
like men, instead of fighting among our- 
selves like brutes. — Medical Standard, 

Sunlight the Best Germicide. — Dr. 
William Brady, of Elmira, N. Y., in the 



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New York Medical Journal says : Sunlight, 
the best germicide known to medicine, costs 
nothing. Cold fresh air, the best tonic in 
the world, is free to all. Only the housed 
up mollycoddles need blood purifiers in the 
spring. No one ever caught coryza or 
pneumonia out in the open. These are 
house infections. No more domesticated 
germ exists than the pneumococcus. 

Tinea Versicolor. — ^A 25 per cent, solu- 
tion of sodium hyposulphite will cure any 
and every case of tinea versicolor, says Dr. 
A. M. Wilson, of Kansas City, Mo., in the 
N. Y. Medical Journal, I have had a very 
large and extensive experience in the treat- 
ment of the disease under consideration 
and have never had a failure with the agent 
mentioneo. 



LOBELIA IN ASTHMA. 

Dr. Vance, of Somerset, Ind., in a late 
issue of Ellingwood's Therapeutist, says : I 
recently surprised myself and my patient a 
great deal more, when on being called to a 
very severe case of asthma, with all the 
disagreeable symptoms exaggerated, I ad- 
ministered a hypodermic of 30 drops of lo- 
belia. Almost immediately the patient had 
relief. The benefit was marked right from 
the first. After half an hour I gave 15 
drops more, and the patient laid down and 
slept as quietly and as naturally as ever in 
his life. 



THE X-RAY. 



In the few years gone by, we have found 
that the x-ray is not a cure for all diseases • 
that it has its good results in the therapy, 
as it had many failures. The failures, be- 
ing due to zealots, who treated everything 
everywhere, without making the proper 
diagnosis; without the knowledge of the 
pathology of the respective lesions, using 
the rays as a leading fad, instead of an 
accessory to already known methods, and 
injuring the permanency of its hold on the 
really scientific opinion of a good and hon- 
est man. At the present time, however, the 
x-ray treatment is on a safer basis, and 
what it has lost through the desertion of 
the faddist, with their so-called "bums," 
etc., it has gained through the accession of 



many workers who use the Roentgen rays 
as a means of therapy in suitable cases 
only, getting now far better results from 
their systematic and proper application.— 
Dr, Rudis-Jicinsky, of Cedar Rapids, la., in 
Medical Brief. 



PINEAPPLE JUICE. 



It is stated that the juice of the fresh 
pineapple has been successfully used in 
quinsy. When the abscess has formed, and 
the overlying tissues have become damaged, 
the juice readily digests them, opens the 
abscess without pain, obviates the use of a 
surgeon's knife, and shortens by several 
hours or days the period of misery often 
endured by the timid person who is afraid 
of a surgical operation. In cases where a 
boil has come to a head, and the patient is 
afraid of the knife, the application of fresh 
pineapple pulp will cause the tissues to dis- 
solve, and give relief in a short time. 



ENEMA IN GASTROENTERIC DISEASES. 

Charles J. Drueck, of Chicago, 111., gives 
a resume of the value of the enema and its 
proper method of administration in diseases 
of the gastro-intestinal system. It is in 
reach in every household, is without danger 
when given properly, is prompt and posi- 
tive in its results, and of value when indi- 
cations are correct. He gives simple ene- 
mata of a small amount of cold water in 
constipation, to stimulate peristalsis. They 
are better for this purpose than warm ones. 
It is of value in reducing temperature; also 
removes decomposing materials, and bene- 
fits the portal circulation. The hot enema 
is useful in treatment of pelvic inflanuna- 
tion; it increases blood-pressure, acceler- 
ates the heart action, and stimulates the 
kidneys. It is especially valuable in the 
treatment of pseudomembraneous colitis. 
Hot irrigation is useful in inflammation of 
surrounding tissues, rectal ulcer, spasm of 
the sphincter, and gynecological diseases. 
In cholera infantum and cholera morbus 
the hot enema removes irritation and in- 
fectious materials, and stimulates the heart 
In colitis and chronic diarrhea, peritonitis, 
and typhoid fever it is of value. — Medical 
Record, 



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TU qMia k dM iM« «w^ d» Amwm wifak oitf ImJvmI iMaM nay U pIsMid to eead 



THE PUERPERIUM. 

£(ffVor Medical Summary: 

After the completion of the third stage 
of labor the physician should make a phy- 
sical examination of the pelvic floor, and if 
any injuries exist they should be repaired 
at once if possible. Primary union is the 
rule; should it not take place the patient is 
more satisfied as to your having done your 
duty and is willing to have a secondary re- 
pair at the end of ten days. 

During the active labor pains the patient 
usually perspires very freely, and the few 
clothes covering her body becomes wet and 
damp. Dry clothing and pads should re- 
place the soiled ones as soon as possible in 
order to prevent a chill. Extra covering 
should be placed over her and a hot water 
bottle applied to her feet will make her 
more comfortable. 

I always apply an abdominal binder un- 
less objected to by the patient, as the re- 
laxed abdominal wall will involute better 
and also obviates the sudden filling of the 
abdominal veins. I always have an as- 
sistant ( the nurse or an attending friend) 
keep her hand on the fundus of the uterus 
until the binder is applied, thus preventing 
the accumulation of clots in the uterine 
cavity and lessen the number and severity 
of after-pains. 

The patient is allowed to assume the lat- 
eral position at will as a prolonged dorsal 
decubitus tends to produce posterior dis- 
placement. She is allowed the use of the 
vessel in bed from the beginning, thus 
avoiding pelvic congestion and favoring 
uterine drainage. I have observed the less 
clots voided the fewer after-pains. No 
vaginal douche is given unless there is some 
special indication for it ; the vulva is bath- 
ed with some antiseptic solution or steril- 



ized water after voiding her urine ; all pads 
placed to the vulva should be sterilized, as 
there are more or less abrasions or in- 
juries to the tissues, and should require the 
same care and cleanliness as a wound in 
any other part of the body. After-pains 
cause a great discomfort to the patient; 
they occur most frequently in the multi- 
para, very frequently associated with the 
formation and expulsion of clots ; they also 
appear in some cases when the child , is 
placed to the breast. After-pains may be 
lessened in number and severity by admin- 
istering specific macrotys, giving a half 
dram or a dram to four ounces of water of 
this, a teaspoonful every one or two hours 
as needed. It assists uterine involution and 
can be given during the first week or ten 
days of the puerperium, until the red color 
of the lochia disappears. 

Until the secretion of "tnilk appears in 
the breasts the baby should be placed to the 
breast at intervals of four hours, after- 
wards at intervals of two hours during the 
day and once or twice during the night. 
As a rule the baby should not be placed to 
each breast at one nursing, but to them 
alternately, thus giving the nipples as long 
a period of rest as possible. During the 
intervals of nursing the nipples should be 
covered with aseptic gauze, the mother 
should be forbidden to take hold of her 
nipples with her fingers. If abrasions oc- 
cur the nipple should be bathed after each 
nursing with some harmless antiseptic so- 
lution like boric acid, and then painted with 
compound tincture of benzoin. If fissures 
occur, the same treatment should be fol- 
lowed, with the addition of a glass nipple 
shield, to be used during each nursing. 

After the secretion of milk becomes well 
established, the breasts become congested 
and the weight causes discomfort, which 
is relieved by a bandage or a tight-fitting 



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corset-cover, which docs not compress the 
breasts but holds them up on the chest 
wall and away from the axillae. If the se- 
cretion of milk is too profuse, a breast 
pump should be gently used occasionally, 
liquids by mouth restricted, and saline lax- 
atives administered. The baby ought to 
get sufficient nourishment from nursing fif- 
teen to twenty minutes. If it continues to 
nurse longer it indicates an insufficient se- 
cretion of milk. Should the secretion of 
milk be scant or insufficient for the infant, 
it can easily be increased by having the 
mother drink plain hot milk, not boiled, 
only hot, or she may be given hot gruels 
and cocoa between meals and at bedtime. 
If the patient has been accustomed to drink 
tea, she may be permitted to continue it, 
but coffee and alcohol stimulants are con- 
traindicated. Water should be given ad 
libitum. 

The starvation diet at the present time 
is obsolete, and neither is an excuse of 
nitrogenous food indicated. In a normal 
puerperium a mixed diet gives the best re- 
sults, except the first two days a light diet 
is advisable. After the bowels have moved 
freely the appetite of the patient may be 
used as a guide. A laxative should be 
given at the end of the first 48 hours, pre- 
ferably castor oil one half of an ounce; if 
objectionable, then a dram of compound 
licorice powder or a Seidlitz powder. 

There is considerable difference of opin- 
ion as to the duration of rest in bed. No 
definite time can be given, as every woman 
is a law unto herself. Uterine involution 
is more rapid in one than in another; as 
long as the lochia is red the woman should 
remain in bed. It is during the puerper- 
ium that attention should be directed to the 
prevention of subinvolution. If the patient 
sits up on the tenth or twelfth day and the 
red lochia returns, the indication is for an 
immediate return to bed. A puerpera should 
remain a week in her room after rising 
from her bed. Her getting up should be 
gradual, as her future health depends on 
the care exercised during the puerperium. 
She should not resume her household 
duties until involution is complete, which 
is from five to six weeks. 

As a routine the last visit made by the 
physician to his patient he should insist on 



her calling at his office, or if preferred he 
should arrange for a visit to her home at 
the completion of the puerperium for an 
examination, as if any minor derangements 
exist they could be discovered and treated 
at once, but if let untreated would possibly 
become aggravated by time and the physi- 
cian censured for latent complications. 

E. N. RiTTER, M.D 
Williamsport, Pa. 



"PECULIAR SKIN TROUBLE."— TYPO- 
GRAPHICAL ERRORS, ETC. 



Editor Medical Summary: 

I^r. Davis, of Summit Point, W. Va., 
tells of a peculiar skin trouble which would 
show no eruption, but at night would be- 
come intolerable; and he finally hit on 
balsam Peru and white vaseline, which 
gave relief. I guess many others have had 
such cases to contend with. I had a case 
of an elderly man who was tormented al- 
most to desperation by an itching from the 
knees down as soon as he removed his 
clothing for bed. He said if he did not get 
cured pretty soon he would try the virtues 
of a shotgun. I cured him by an inunction 
of quinine, carbolic acid and oil of eucal- 
yptus. Also gave him a large dose every 
night of sulphur praecipitatum two parts 
and cream of tartar four parts ; dose table- 
spoonful. Finally put him on arsenauro, 
10 drops three times a day. 

There are very few more exasperating 
things than typographical errors. The 
Summary made me say "rebound" when I 
wrote "redound." Frequently such errors 
by proof-readers destroy the beauty and 
sense of a paragraph. I give the Summary 
credit, however, of making very few mis- 
takes in printing a MSS. Some journals 
are simply awful, and make an author feel 
silly. To be sure, some writers form such 
abominal ungrammatical sentences that no 
editor can be blamed if such sentences arc 
bad, as he is not supposed to take the time 
and trouble to rewrite bad grammar. 

D. L. Field, M.D. 
Jeffersonville, Ind. 



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153 



RANDOM NOTES FROM PRACTICE.— CON- 
SUMPTION, CANCER, ETC. 

Editor Medical Summary: 

Possibly I may be called an old fugy, but 
that gives me but little concern, so long as 
I cure my patients, or so long as they re- 
cover under my treatment. 

The object of the physician is to cure 
his patients, whether that is accomplished 
by old, well tried methods or by new ideas, 
it matters not. First and foremost let us 
cure our patients. I have been condemned 
at times for the methods used, being nomi- 
nated obsolete. 

I am practicing medicine for the purpose 
of curing my patients, and the more I cure 
the better satisfied I am. Take my practice 
of nearly sixty years, and compare any part 
of it with the new ideas, and I think it will 
be found that I have at least been as suc- 
cessful as any of my neighbors. 

I by no means condemn new; ideas and 
new methods of treatment, so far as they 
have proven successful and better than the 
old, I have accepted them. But to say that 
all new ideas and methods of treatment are 
superior and better than the old ideas and 
methods, I emphatically deny. What bet- 
ter treatment, pray tell, have we ever had 
for s)rphilis than the old treatment of mer- 
cury and iodide of potassium? Wh^t bet- 
ter treatment for malaria and chills and 
fever has ever been discovered than mer- 
cury and quinine? I pause for a reply. 

I might mention a number of other dis- 
eases, but I do not think it necessary. Is 
there any better remedy for certain condi- 
tions than opium in some form? I answer 
no. Is there any better physic than castor 
oil and Epsom salts? We know there is 
not. I might mention many other well- 
known and efficient remedies, but I forbear. 
Now, in regard to consumption. Are all 
of the tuberculous hospitals and appliances 
curing any more cases of tuberculoses than 
were cured twenty years ago? We know 
they are not. Now, I do not wish to estab- 
lish the idea that the methods now used to 
prevent and cure diseases of the lungs are 
objectionable — I certainly do not, but that 
they are curative of lung diseases I abso- 
lutely deny. I do not believe a consump- 



tive patient has ever had too much real 
scientific ' care or attention, but that this 
care and attention is reducing the number 
of cases I do not believe. So long as we 
have predisposition to consumption by par- 
entage I believe we will have consumption. 

The consumptive hospitals are not ob- 
jectionable, as we have better scientific 
principles governing them than in private 
practice, but they do not and never will 
cure consumption. Good sanitary condi- 
tions must be enforced in regard to con- 
sumption as well as other diseases. Give 
us good food, good water, good air and 
good inheritance and we will not have con- 
sumption or any other disease. But allow 
the human family to live in poorly ventil- 
ated rooms, to work in poorly ventilated 
offices, to eat a poor diet, and we most as- 
suredly will have consumption and many 
other avoidable diseases. 

Sanitation is one of the necessary things 
to be taught to the coming generation. As 
time progresses we are learning more and 
more in regard to the laws of health. This 
is as it should' be, not only in regard to 
consumption but in regard to many other, 
yes, I think I am safe in saying, all other 
diseases. We can never know too much 
about ourselves. 

I am still following my old specialty, the 
treatment of rectal, bowel and stomach dis- 
eases. I have, I believe, learned some 
things which will be of marked benefit to 
the medical profession. First I have learn- 
ed that it is seldom ever necessary to send 
a patient to bed for the treatment of any 
rectal disease. That a patient does any 
better, as a rule, to be confined to bed, I 
do not believe. They generally do better 
if they are able to be around during these 
treatments. 

Bed has, I candidly think, a bad eflFect 
upon all rectal diseases. I am not sure, 
but what we could honestly say it has a 
bad effect upon the majority of all diseases. 
Of course, there are diseases where bed is 
demanded, and in that event the bed is the 
better place, but how often it is that we 
keep our patients in bed to their detriment 

Put a consumptive to bed and he will die 
much sooner than he would if allowed to 
take moderate and scientific exercises. In 
my treatment of rectal diseases or stomach 



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and bowel diseases, I make it obligatory 
that my patient be up and around. Of 
course, we do run across diseases where 
this would be imprudent, but the category 
of such cases are becoming less and less 
yearly in my practice. 

I find constipation prevails with about 
three-fourths of the human family. I hon- 
estly believe that it is the cause of three- 
fourths of the diseases that prevail. My 
primal object is, in nearly all cases I treat, 
to have at least one action of the bowels 
during the twenty-four hours. If I can 
accomplish this then more than one-half of 
my treatment is accomplished. If I can 
succeed in having one good action of the 
bowels during every twenty-four hours I 
can almost safely promise my patient re- 
covery. That this can be accomplished by 
the use of medicine alone, I do not believe. 

The treatment I use for chronic constipa- 
tion is massage with faradic electricity. 
This message has to be performed in the 
proper way or else no benefit results. 

I use a comparatively strong current. 
I have my patient hold one pole of the bat- 
tery, I hold the other, and change the pole 
several times during the fifteen minutes' 
treatment. I massage, following the colon, 
and also the stomach and liver. This needs 
to be repeated from twenty to fifty times. 
I seldom ever fail in curing constipation if 
the patient will follow my treatment a suf- 
ficient length of time. We can occasion- 
ally cure with five treatments, more fre- 
quently with ten or twenty. I seldom ever 
fail to cure with thirty or forty treatments. 
During the first week or two, I treat about 
three times a week, and may have to give 
the patient some medicine to assist in the 
treatment. 

I rarely have to give any medicine after 
the four weeks' treatment. My observa- 
tion is that the cure is permanent, if the 
patient will persist in regularity in eating 
and going to the toilet after the treatment; 
there is no return of the constipation. It 
is to be expected that we would live a sani- 
tary life in eating, drinking, exercising and 
sleeping. 

I find that many stomach diseases are 
much benefitted by massage and electricity. 
In fact believe all, unless malignance is 
present, can be cured by this treatment. 



Very fortunate it is that we have very 
few cancerous conditions prevailing with 
the stomach troubles that fall into my 
hands. If cancer be not present we can, 
as a rule, honestly promise benefit in the 
treatment of these diseases. If cancer be 
present we had better exercise great care 
in what we say to our patients. I know it 
is a difficult matter to diagnose cancer of 
the intestinal tract, especially of the stom- 
ach, and in our diagnose we had better 
leave a loop open so we can avoid an abso- 
lute diagnosis. 

In the treatment of internal hemorrhoids 
I suggest treatment at any time the patient 
may come into your hands. Of course cer- 
tain preparation is necessary. The empty- 
ing of the bowels being the most necessary. 
I do this with a few j4-grain calomel tab- 
lets, follow this with half an ounce of cas- 
tor oil. When the desired eflFect is accom- 
plished I treat the hemorrhoids. I have 
cut down my treatment to two methods. 
The hypodermic and sigature; I think two 
better methods of treatment have never 
been instituted or invented, either one will 
absolutely cure. When the piles are gotten 
rid of we must treat the stomach trouble 
and cure the constipation. If other trou- 
bles, as enlargement of the liver of colon, 
indigestion, kidney trouble, etc., be present, 
they must be treated. If we do not get rid 
of thege diseases we are liable to have the 
hemorrhoids reproduced. If we get rid of 
them there will be no more hemorrhoids. 

My system of dieting of late years has 
been no cast iron rule. I perhaps suggest 
a suitable diet, but I impress the following 
idea upon the mind of my patient If he 
eats anything that does not digest well, that 
is, if he by regurgitation tastes in four or 
hve hours after having eaten he must avoid 
this food, at least temporarily. Nearly 
everybody will belch more or less after eat- 
ing, this being governed, to a great extent, 
by the food eaten, but it ought to cease in 
three hours after eating. 

Belching, as a rule, should not exist, and 
if we have complete digestion with the ma- 
jority of articles eaten it will not occur. 
But whenever we eat onions, cabbage, cu- 
cumbers, and many other articles of diet, 
who has not had regurgitation or belching 
as it is called by the laity, resulting from 



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155 



certain foods having been eaten and in the 
majority of instances where this does oc- 
cur there is really no indigestion present. 
Such a condition is perfectly natural very 
often and requires no attention. This 
should be explained to our patients to con- 
vince them that it is natural. We do find 
patients whom we cannot convince of this, 
then we are almost compelled to do some- 
thing. I use in these cases the soda mint 
tablets and find them better when combined 
with a small quantity of carbonate of am- 
monia. These mint tablets, by the way, are 
very useful in all cases where there is an 
excess of acids, but nothing in my opinion 
will set the liver to work so well as calomel. 

I think, however, sometimes we use too 
small doses of this valuable medicine. I 
now use the quarter or half grain tablet 
until about four grains are taken. Of 
course, a few years ago we used altogether 
too much calomel, then for a number of 
years I verily believe we used too little. 
My experience teaches me that the four 
grains are better than one, two or three 
grains. I believe that we have to have a 
decided eflFect of mercury, whatever form 
used, and I do not believe that we obtain 
that effect in less than the four grains. 
This I have learned from actual experience 
which is a good teacher. 

The cry of late is, do not use more than 
one grain of calomel, and that in divided 
doses. I have tried this and have not had 
the desired results. I seldom ever fail, 
however, with the four grains. Calomel 
when used always ought to be followed by 
some gentle laxative, and the best I know 
of is castor oil. The patients who cannot 
or think they cannot take castor oil, we 
frequently find in that case we have to use 
some other laxative, epsom salts, sedlitz 
powders, phosphate of soda or the old- 
fashioned rheubarb and aloes does very 
well as we find it in Cook's pills. Very of- 
ten this has to be repeated several times 
before we set the liver to performing its 
natural functions. Empty the intestinal 
tract should, as a rule, be the war cry. 
With a clean stomach and bowels we may 
expect some good results from our medi- 
cinal treatment. 

It has been my lot to see a great many 
cases of chanchroid. Not long ago a pa- 



tient came to me with the penis one con- 
tinual ulcer. He had been having this con- 
dition something over a year. His physi- 
cian finally pronounced the disease cancer. 
The case was by no means a promising one. 
My diagnosis to a great extent was the re- 
sult of his gaining flesh instead of losing it. 
A cancerous patient does not gain flesh. 
This gentleman had gained some thirty 
pounds in three months. I pronounced the 
case chancroid. Having decided it was not 
cancer, I began treatment by two applica- 
tions to the entire ulcerated surface of ni- 
trate of silver, 40 grains to the ounce. 
This I followed by the free application of 
the dry calomel and Squibb's talcum pow- 
der every day. I have treated him five 
weeks and the sores are ail healed. The 
penis is now about normal in size, he can 
urinate without difficulty, has no annoying 
pain to keep him awake; of course, I kept 
his bowels acting. He has gained some 
twenty pounds during the treatment. I told 
him yesterday he might go to work again. 

A bad and incorrect diagnosis has been 
the cause of much suffering from improper 
treatment. Were I to chose between doc- 
tors, I should always chose the best diag- 
nostitian. Geo. J. Monroe, M.D. 

Room 618 The Paul Jones, 
Louisville, Ky. 



EPIDEMIC MENINGITIS. 

Editor Medical Summary: 

What causes epidemic meningitis? Is it 
cold, malaria, dampness, or unsanitary sur- 
roundings? It only prevails in the spring 
and fall, as the rule. It is usually a dis- 
ease of childhood, but this year it is no re- 
spector of age. However, it is rare after 
fifty years of age. In looking over the au- 
thorities, you will find they don't know the 
cause. They guess all sorts of probable 
causes, but you can do that yourself. It is 
almost an epidemic in Louisville now, but 
we live just across the river from that city, 
and while we have about sixteen thousand 
population, there is not a case reported. To 
be sure, we have plenty of sea-room, no 
flat-dwellers, plenty of fresh' air, good 
water, and live right 

D. L. Field, M.D. 
Jeffersonville, Ind 



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MUSCXFLAR SHSUMATISH. 

Editor Medical Summary: 

Will you kindly publish in next issue one - 
or two good formulas for muscular rheu- 
matism ; also one or two reliable formulas 
for chronic kidney trouble? Thanking you 
in advance for the favor, I am respectfully, 
Subscriber, M.D. 

[Ready-made prescriptions for muscular 
rheumatism, as well as nearly all other 
mortal ailments, are not altogether reliable. 
In this affection diaphoretic, diuretic and 
analgesic medication should constitute a 
tripartite alliance. Dover's powder is both 
sedative and diaphoretic. For the latter 
nitrate of potassium and lithium bromide 
are also indicated remedies. In chronic and 
rebellious cases a course of treatment with 
colchicine and potassium iodide will be ser- 
viceable. In such cases the hepatic and 
renal functions need stimulation. In the 
beginning of an acute attack salicylate of 
soda, reinforced judiciously with a coal tar 
product, plus hepatic elimination, often cuts 
short the attack. Dry heat is highly ser- 
viceable, coupled with a few days of abso- 
lute rest. Alcohol and oil of wintergreen 
make a good liniment; chloroform may be 
added to it. We have tried out a number 
of the natural mineral waters claimed to 
have a certain value in these cases, and 
among those tried find several that we be- 
lieve to have been productive of good re- 
sults. These are the Manacea and the 
Mecklenburg mineral waters. Of course, 
you will say, any good water given in suf- 
ficient quantity to thoroughly flush the kid- 
neys would have answered the purpose just 
as well. In reply to this, allow us to state 
that in several cases of muscular • rheuma- 
tism we have tried this, in conjunction with 
remedies generally recommended by the 
authorities in standard text-books, without 
success. Finally, our patient becoming dis- 
couraged, having incessant pain, almost un- 
bearable, we advised the exclusive use of 
one of the waters above mentioned, with 
massage of the affected muscles about 
every other day, with perfectly satisfactory 
results. 

As to formulas for "chronic kidney trou- 



ble,'' so much depends upon the specific 
character of the ailment. Even different 
types of nephritis may call for radically 
different lines of medication. The question 
is partially answered above. The diet and 
hygiene are, after all, the most important 
factors in chronic renal affections. Water 
is our best diuretic and it is seldom con- 
traindicated even when taken voluminously. 
Buttermilk is indicated in most cases in 
which the kidneys are damaged or their 
function perverted. Alkaline diuretics well 
diluted and taken freely hit a good many 
cases. The question is before the house, 
and we welcome suggestions on these topics 
from our readers. — Ed.] 



NOTES FROM A GENERAL PRACTITIONER. 

Editor Medical Summary: 

So many doctors are always making the 
complaint that they have no time for any- 
thing else outside of routine business — ^no 
time to read medical journals and books, to 
say nothing of literature of a general or 
collateral character. It has always been a 
contention of my own that any one, physi- 
cian or who not, with a thirst for learning, 
can always find time to read, reflect and 
investigate. I do not pose as a "shining 
example" of this theory made carnate, and 
still a personal note might not be wholly 
irrelevant I have always been a very 
humble general practitioner, but profession- 
al work together with my years of dabbling 
in both lay and medical literature have kept 
me quite busy. Still I have taken a good 
deal of time to acquaint myself along varied 
and versatile fields of endeavor. 

Time is saved in the end by doing prompt- 
ly and at once whatever has to be done. 
If calls are to be made, I get them out of 
the way as soon as I can. Having always 
dispensed, I make it a rule to put up medi- 
cine as soon as I can; if called away, the 
stuff is ready at the office when it is called 
for. If a urinalysis or other specimen is 
to be looked after, it pays to do it at once 
and have it over. Being examiner for sev- 
eral insurance companies, I learned long 
ago not to let applications pile up on me. 
I feel better if I can go to bed without an 



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THE MEDICAL SUMMARY 



157 



application on my desk. I make out birth 
and death reports promptly; then I know 
they will not be forgotten. A physician 
here got "in bad" a year or so ago for in- 
advertently failing to make a birth report. 

When other matters are all cleaned up 
and out of the way, you have more time 
that is really your own. How will you 
utilize this time? We must have a little 
fun as we go along and pay some attention 
to the social amenities of life. "All work 
and no play" — ^you know the rest. Still, it 
doesn't pay to fritter your time away in 
useless gossip perched on the second-story 
of a goodsbox in some store. The good 
"mixer" is usually a good deal of a "loafer." 
While I must confess that my attainments 
are very mediocre, yet I sometimes wonder 
how I would have fared had I always fool- 
ed my time away as so many men do. 

I make it a rule to always have with me 
a magazine or medical journal, and while 
on the street cars very valuable browsing 
may be done. It is a good rule to have a 
medical journal or small book in the ob- 
stetrical bag. Oceans of valuable time ebb 
away when one is anchored to these cases. 
You are too far away to go home, so you 
must tough it out as best you can. Former- 
ly I made it a rule not to read or sleep 
while while on a confinement case. The 
parturient woman regards herself the whole 
show and wants all your attention. As I 
have grown older in experience, I have 
learned to give the sick woman only what 
attention she needs, not what she thinks 
she needs. If the case is slow-going, but it 
is inadvisable to leave it, I feed my mind 
with printed pabulum or my nerve cells 
with invigorating sleep. If there is any 
"moral" to these remarks it is this: Con- 
serve your time and your energy and im- 
prove and enjoy yourself while at the game. 

I have read a reprint on "Sanitarium 
Treatment of Tuberculosis in Private Prac- 
tice," by Dr. J. H. Mudgett, Philadelphia, 
and note his success in the use of tubercu- 
lin. Will the doctor write and give in a 
brief, succinct manner his experience with 
this agency? Summary readers would 
doubtless be pleased to hear definite reports 
from the doctor in the use of this remedy. 
W. T. Marrs, M.D. 

Arkinda, Ark. 



SITTING UP AFTER LABOR. 

Editor Medical Summary: 

My hand upon your editorial on the 
"Post-Partum Stage" in the April Sum- 
mary. "Getting up does not hurt the wo- 
man just recently delivered; it is the stay- 
ing up that hurts her." 

Well said, or written. In the first hours 
after labor, the obstetrician is obsessed by 
the dread of post-partum hemorrhage, a 
rarely fatal accident or catastrophe. If it 
was frequent the deaths from it in such a 
place as New York city, where about one- 
half of the cases of labor are attended by 
midwives, would be appalling. 

In olden times the seat of amputation 
was drained, so it is of benefit to drain tlr.e 
wounded uterus and vagina. Instruction 
should be emphatically given by the atten- 
dant that the patient sit up and urinate a 
few hours after delivery, otherwise the 
neck of the bladder may have become so 
obtunded by pressure during labor that it 
may become necessary to use a catheter. 
When the woman urinates in the upright 
posture, the uterus and vagina are natural- 
ly drained. 

I may write that I have followed this in- 
junction from Lusk for many years, and 
have never had any hemorrhage as a re- 
sult, nor have I used a catheter. I have 
never had or caused a case of puerperal 
fever, and do not use gloves, although I 
favor the use of them. Truly our paths 
are happy or unhappy, according to the 
"personal equation." I never use forceps. 
The woman is allowed to use the position 
of preference, but when there is a tendency 
to prolong labor, and the conditions are 
right, I make her kneel, and the labor is 
soon over. 

I may add that Dr. O. B. Surface wrote 
well on "Instrumental Delivery" in your 
April journal, but I have to write that I 
think we are badly educating the public re- 
specting the frequent use of forceps. It 
has become to associate forceps with us 
as with the dentists. A pair should be car- 
ried to every case of labor, but usually it 
is better to let them act as if by catalysis, 
solely by their presence in the bag. 

Thomas R. Evans, M.D. 

Huntington, W. Va. 



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- ^^ou to be of ptactt4 

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a ap erience has convineed you to be of j 

Fonnnlas plainly written on postal 

1 . Name ol disease. 2. The fonnula and diiectioM. 3. Your name, toiwn 



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way foe 



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I you m tune to 
the Summary. 




r. Always live 
and Slate. 
It is ouc widi that the reader take 



TREATMENT FOR GONORRHEA. 

Editor Medical Summary: 

The following internal remedy can be 
used with good results in most any case of 
gonorrhea : 

5^ Potassium bromide 5iv. 

Sodium bicarbonate 5J» 

Tine, cannabis indica 5iv. 

Spts. aeth. nitros 3"J- 

Aqua q.s. ad ^vj. 

M. Sig. — Teaspoonful three times a day. 

As an astringent use: 

5^ Ext. pinus canadinsis (white) Jij. 

Tinct. opium, 

Glycerin aa 5^ss. 

Aqua rosae ... * q.s. ad ^vj. 

M. Sig. — Inject every three hours. 

A similar injection is 

5^ Ext. pinus canadinsis (white) Jij. 

Mucilage acacia 3^^^. 

Aqua rosae q.s. ad Jiv. 

M. Sig. — ^Use as an injection every four 
hours. 

J. A. BtJRNETT, M.D. 
Arkinda, Ark. 



FOR CHRONIC RHEUMATISM, ETC. 

Editor Medical Summary: 

Here is my favorite prescription for 
chronic rheumatism and to free the system 
from uric acid. It favors normal metabol- 
ism and feeds the nervous system and 
strengthens the great sympathetic chain so 
that it acts as a better monitor to functions. 
This formula has done more for me than 
any remedy employed for years : 
^ Phosphoric acid (Squibbs) 85% 

solution 5iiss. 

Sulph. magnesia, 

Syr. simp aa 3»v. 

Aqua q.s. $xu. 



M. Sig. — Two teaspoonfuls before meals 
in half glass of water. 

To have a permanent effect it should be 
taken for about six weeks. 

For Spasmodic Asthma. 

Use hypodermically, adrenalin, 15 drops; 
apomorphine, 1/30 of a grain, and it gives 
speedy relief in the catarrhal or spasmodic 
form. 

For Urticaria. 

Try this formula in urticaria: 

5^ Strontium bromide 5ss. 

Aqua, q.s.. 
Essence pancreas. 

Essence pepsin aa Jij. 

M. Sig. — Two teaspoonfuls after meals 
in one-fourth glass of water. 

A. V. Banes, M.D. 
St. Joseph, Mo. 



LINIMENTS. 



Liniments are old-fashioned, but they 
always serve the purpose of amusing the 
patient and have a modicum of real value 
besides. Here is one cribbed from Physic 
cians* Drug News: 

Tinct. aconite, 

Chloroform, 

Oil gaultheria aa one ounce. 

Soap liniment q.s. one ounce. 
Here is another: 

Oleoresin capsicum, 5 parts. 

Oil wintergreen, 2 parts. 

Oil sassafras, 2 parts. 

Menthol, i part. 

Yellow wax, 3 parts. 

Lard (or petrolatum), 26 parts. 
Melt the wax and lard and when nearly 
cool add the oils and mix well. If a liquid 
liniment is desired use alcohol 33 parts in 
place of the lard and wax. 



158 



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AO Book* i cy ie w<jd m diH deportment, wiD be tent poetpoid hv tbe poUuher ol the Sumosorr 
upon receipt ol the price quotoo. 




False Modesty that Protects Vice by 
Ignorance. By E. B. Lowry, M.D., au- 
thor of "Confidences," "Truths," "Her- 
self," etc. Forbes & Company, Publish- 
ers, 443 S. Dearborn St., Chicago, 111. 
19 1 2. Price, 50 cents. 

When the attention of the world in gen- 
eral was first awakened to the appalling ex- 
tent of the white slave traffic, as shown by 
a campaign of publicity, teachers, ministers, 
club women, and educators generally, be- 
gan to look for a remedy. Investigations 
indicated that the cure lay in prevention, 
and the most potent remedy in prevention 
was the education of the masses to a know- 
ledge of what was transpiring in their own 
communities, even in their own homes, and 
the cause for it. 

The aim of the author of this little book 
has been to bring these facts to the atten- 
tion of fathers and mothers, to show them 
the necessity of early and proper instruc- 
tion for both boys and girls in matters per- 
taining to sex, etc. All of Dr. Lowry's 
books are excellent. The present one is of 
vital, helpful interest, and should be read 
by every parent. 



The Influence of Caffein on Mental 
and Motor Efficiency. By H. L. Hol- 
lingworth, Ph.D., Instructor in Psychol- 
ogy, Barnard College, Columbia Univer- 
sity. Archives of Psychology, edited by 
R. S. Woodworth. No. 22, April, 1912. 
Columbia Contributions to Philosophy and 
Psychology, Vol. X, No. 4. The Science 
Press, Publishers, New York. 191 2. 

In this neatly printed monograph, com- 
prising 166 pages, the author presents full 
and complete records of an elaborate and 
extended investigation on the influence of 
caffein on mental and motor processes, 
along with the conclusions, based on his 
own careful study of the records, free from 
all suggestion of prejudice or bias. 



The Treatment of Short Sight. • By 
Prof. Dr. J. Hirschberg, Geh. Med. Rat 
in Berlin. Translated by G. Lindsay 
Johnson, M.D., F. R. C. A., with twelve 
illustrations. Rebman Company, Pub- 
lishers, 1 123 Broadway, New York. 1912. 
Price, $1.25 net. 

This small volume embodies the subject 
of a lecture delivered by the author and 
published in the "German Clinic" several 
years ago. The exceptionally large and 
extended experience of Professor Hirsch- 
berg of several decades in ophthalmic prac- 
tice, and his marvellous power of observa- 
tion renders this book of exceptional value 
not only to the student, but also to the spe- 
cialist in ophthalmic work. The translator 
says that he knows of no work that covers 
the ground so exhaustively. This volume 
has a double value, not only in guiding 
those who fit glasses to correct myopia in a 
scientific manner, but also, which is of more 
importance, in pointing out the dangers and 
pitfalls which beset those who attempt to 
correct high degrees of myopia, without 
that special knowledge which only a large 
experience in ophthalmic practice can give. 



WHICH? WHY? 



Doctor, why do you administer atropine 
in preference to strychnine as a stimulent? 
Evidently you have a reason. Please let 
the Summary have it. The editor is very 
desirous that some one write an article for 
this journal, and give the scientific deduc- 
tions for the use of sulphate of magnesium, 
the actions of the drug, and the reason for 

. its extensive use during the last decade in 
certain affections. Let's have your ideas. 
Another thought, why do you administer 
the fluidextract of ergot in preference to 
any other preparation of the drug? Your 

conclusions will be read with interest. 

159 



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Many children can digest the proteids of 
cow's milk when a little barley water is 
added. 

Gelsemium and gelseminine are useful in 
most types of insomnia. It is an indicated 
remedy in all cases of cerebral hyperemia. 

Infantile diarrhea is generally caused by 
indigestion due either to bacteria in the 
food or to indigestible material in the food. 

Sweet spirits of nitre is a valuable rem- 
edy for dermatitis of vegetable origin. The 
earlier it is employed the more likely it is 
to abort the inflammation. 

Incontinence of urine occurring in wo- 
men, when this condition is due to a paral- 
ysis of the vesical muscle-fibers, is cured 
by gelsemium. 

The plants now cultivated in the United 
States on a commercial scale are pepper- 
mint, goldenseal, ginseng, wormseed and 
wormwood. 

If the mother has tuberculosis, chorea, 
epilepsy, insanity, or if there has been hem- 
orrhage, eclampsia, nephritis or septicemia, 
the baby should not nurse the breasts. 

Echinacea is an excellent remedy in all 
conditions when sepsis needs to be correct- 
ed, as in boils, carbuncles, septicemia, and a 
tendency to the formation of abscesses. 

The following causes make weaning nec- 
essary : pregnancy, acute or chronic disease 
of a serious nature, mastitis of both breasts, 
progressive loss of u'eight for several weeks. 

In using iodine for sterilization of oper- 
ative field, the solution of the tincture 
should be made fresh weekly as old tincture 
of iodine undergoes chemical changes that 
are irritative to the skin. 

In erysipelas paint the affected area with 
tincture of iodine; allow to dry and then 
cover with flexible collodion. Pilocarpine 
internally if the case is a sthenic one. 



Remember echinacea in your next case 
of erysipelas, as it has benefitted cases 
where nothing else would do any good; in 
fact, cured them. 

During confinement, when the os is rigid 
and labor is retarded, with the patient high- 
ly nervous, the exhibition of gelsemium in 
conjunction with caulophyllin will be pro- 
ductive of excellent results. 

In the thrush of infants give limcwatcr 
before nursing or feeding. Cleanse the 
mouth with boracic acid solution. Chlorate 
of potash is the old remedy for thrush, but 
is not now so generally used. 

Flushed face, bright eyes and contracted 
pupils are indications for the administra- 
tion of gelsemium. Give small, frequently 
repeated doses until the indications of irri- 
tation are removed. 

Silver iodide is being warmly recommend- 
ed for the treatment of whooping cough. 
It is given in doses of from i/8 to i/6 gr. 
every six hours. It may well be associated 
with atropine, which is probably the best 
single remedy to control the paroxysms. 

The Medical Standard says that thyroid 
is the latest remedy to be suggested for the 
treatment of enuresis. Dr. Leonard Wil- 
liams gives it to children in doses of l4 
grain three times daily. Some one try it 
and write up the experience for Summary. 

In capillary bronchitis atropine is an 
ideal respiratory stimulant, relieving con- 
gested nerve centers and bringing the blood 
to the periphery. Administered hypoder- 
mically it usually breaks an asthmatic par- 
oxysm and obviates the need of giving 
opiate drugs. 

Guarana was at one time used quite ex- 
tensively for headache, but since the thyn- 
thetic preparations have come in vogue lit- 
tle has been said about guarana. It should, 
however, not be overlooked in headache re- 
sultant from anemia ; in some such cases it 
proves very beneficial. 



163 



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A MoDtUy Journal o( 

Practical M£dicine. N£w Pr£paration& Etc. 

R. H. ANDREWS, M.Dm E^tor and Publ}sher» 2321 Park Ave., FhOa.. Pa. 
On« Dollar Pnr Annmii io Advaace. Siatfe Copies, 10 Ceoti 



Vol XXXIV. 



Philadelphia, August. 1912. 



Na 6 



SUB8OBIPTION RATES: 11.00 pw j—x. In ad- 
▼moe, to any psrt of tiio Unitod BUtes and 
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HOW TO REMIT: A lafo way to remit U by postal 
money order, express order, check, draft, or rsgis- 
tered mall. Onrreney sent by ordinary mall asn- 
aUy reaches Its destination safely, bnt money so 
sent most be at the risk of the sender. 

RECEIPTS: The receipt of all money is immedi- 
ately acknowledged by a postal card. 

OHAKOES OF ADDRESS: Subscribers changing their 
addreBses should immediately notify us of their 
present and past locations. We cannot hold our- 
ielvee responsible for non-receipt of the Journal 
in sneh cases, unless we are thus notified. 

DIBOOHTINXrANCBS: The Summary is continued to 
responsible subscribers until the publisher is noti- 
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The Summary continued for another year after 
tlie time paid for has expired, please notify as to 
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'THE MEDICAL SUMMARY,' 



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Entered at Phila. Post Office as second-class matter. 



QUICK BMBSIS. 

In case of choking, poisoning and other 
conditions it is often desirable to empty 
the stomach promptly. Vomiting is almost 
invariably produced by thrusting a long, 
energetic finger far into the throat. This 
should be followed by a glass of warm 
water, to which has been added a teaspoon 
of dry mustard. If ipecac, wine or syrup, 
is used, a teaspoon should be given to a 



child and a tablespoon to an adult. It 
should be followed by a drink of warm 
water and the index finger again inserted. 
Generally speaking the finger method is 
quite successful in bringing about emesis, 
especially after narcotic poison has been 
taken. In case of opium poison the stom- 
ach is often in a lethargic state, due to the 
benumbing effects of the drug, and com- 
bined measures may often need be called 
into service. Apomorphine hypodermically 
in I /to grain dose will as a rule produce 
vomiting in less than five minutes. 



BLADDER CATHETERIZATION. 

Filling the urethra with warm olive oil 
will sometimes facilitate the introduction 
of a catheter when it is otherwise difficult 
Cocaine should be used with caution when 
employed for urethral anesthesia. Some 
authorities state that two drams of a five 
per cent, solution may be injected into the 
urethra with safety, although we should 
think it might produce toxic symptoms in a 
person peculiarly susceptible to the drug. 
A death has been reported from a small 
amount of a ten per cent, solution. It is 
well to remember that it is not best to draw 
off the urine too rapidly, as it may cause 
a collapse of the bladder walls. Cystitis 
may follow upon too frequent and too rapid 
catheterizations. In order for the stream 
to be of smaller volume the catheter should 
not be introduced too far. 



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THE MEDICAL SUMMARY 



lOBINE AS AN ANTISEPTIC AGENT. 

It is a very cheering and refreshing fact 
that in these days of the new and the 
novel; of "high ideals" and "greater aspi- 
rations"; of drug nihilism and iconoclasm, 
when the commonplace and the utilitarian 
are put far back and out of sight to make 
way for the new spirit of progress; when 
we are bewildered by the possibilities of 
science, and confounded by its actualities, — 
it is surely with a sense of great relief to 
turn to such an old-time, old-fashioned, 
mundane actuality as our old friend tinc- 
ture of iodine, who has been rejuvenated, 
and is now disporting himself as one of the 
promptest and most efficient antiseptic 
agents that adorn our modem materia 
medica. 

One hundred years ago, — this is the cen- 
tennial year,— this grand remedy was dis- 
covered by a French soda manufacturer, 
and there is no other remedy that has held 
its place so continuously, uninterruptedly, 
and so tepaceously in the Pharmacopoeia, 
and in the appreciation and confidence of 
the entire medical profession. It is a won- 
derful and curious substance and element, 
and none but the initiated would attribute 
it to its true sourse of production in vege- 
table matter, — so much does it look and act 
like a metallic substance, pure and simple. 

It took but seven years of domestic use 
and empirical experiment before it forced 
itself upon the more scientific notice of the 
medical profession, and from the day of its 
adoption as a legitimate medical claimant, 
its use has ever been on the increase, its 
potency for good has never been ques- 
tioned, and the right of its position in the 
Pharmacopoeia of all countries* has ever 
been maintained. 

It is almost incredible to think that the 
antiseptic property of iodine should have 
eluded medical research for a whole cen- 
tury, when in the meantime it has been 
used as an external application for every 
possible purpose and in every form and 
degree of concentration and dilution. 

A Frenchman discovered it ; a German- 
Frenchman introduced it into medicine; 
and its latest application has had its origin 
in France. All honors to the French ! 

The root of disease lies in the germ; 



and all therapeutic effort is directed to its 
destruction, — whatever the means employ- 
ed to this effect. Great possibilities lie in 
the proper external use of iodine, and it 
seems as if investigators looked beyond 
that which was immediately at their feet in 
their eagerness to discover something new. 

But to be more specific. Tincture of 
iodine has fotmd a wonderfully effective 
use as an application to wounds, both be- 
fore and after infection. It is known that 
the commendable success of the Japanese 
surgeons in the treatment of wounds dur- 
ing the Russian war was owing to the use 
of the tincture of iodine, both as a pre- 
ventive and cure for infected wounds on 
the battlefields and in the hospitals. 

Not only this, but by painting the skin 
with this preparation the surface will be- 
come thoroughly aseptic in a few minutes, 
thus obviating the necessity of using 
other means that require time and that 
may be of impossible use on the spur of the 
moment, or under certain exigencies of the 
case. 

The full-strength tincture is caustic and 
should not be used except under certain 
conditions ; but it should be diluted with al- 
cohol, and not water, since the alcoholic so- 
lution is the most penetrating and it does not 
spread so rapidly over the adjoining parts. 



THE OBSTETRIC EQUIPMENT. 

The physician will never find fault with 
himself for having kept his obstetric bag 
equipped with such remedies, instruments 
and accessories as may be needed in an 
emergency. If he is situated remote from 
drug-stores he should more carefully sub- 
ject his outfit to occasional scrutiny and 
replenish as required. It is not always con- 
venient to carry the Kelley pad, and a very 
good substitute for it in the absence of a 
rubber sheet is to be found in a number of 
folded newspapers. They make a pad quite 
impervious to fluids and are easily disposed 
of. If there is ample time these may be 
crudely quilted together, or they may be 
pinned together with safety pins, and the 
comers pinned to the sheet to keep it all 
from slipping out of place. 

The bag should contain both long and 



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THE MEDICAL SUMMARY 



163 



$hort forceps, hypodermic syringe with 
tablets of H. M. C. or morphine, strychnine, 
atropine, glonoin, veratrine and ergotin. 
Other essential drugs are chloroform, ether, 
brandy, alcohol, acetic acid or iron, car- 
bolic acid or lysol, ergot and chloral hy- 
drate. A fountain or bulb syringe should 
be carried. Also pocket case containing 
scissors, artery forceps, silk and catgut lig- 
atures; uterine dilator, placental forceps, 
dull curet and needle holder. Other use- 
ful articles and accessories are cotton, 
gauze, soap, towels, nail brush, assorted 
safety pins, antiseptic oil or vaseline, t;*l- 
cum powder and boracic acid. For the 
baby's eyes in suspected cases there should 
be convenient a 20 per cent, solution of 
arg>rol or a i per cent, nitrate of silver 
solution. 

Instrtunents that may safely be left at 
home are perforator, craniotomy forceps 
and other wicked instruments of destruc- 
tion in their class. If it should be neces- 
sary to use them they may be secured while 
a consulting physician or two are getting 
on the grourid. Many more articles might 
be named, and some of the above may be 
dispensed with; but it pays to go to an 
obstetrical case well equipped and accidents 
and unpleasant circumstances are not so 
likelv to arise. 



SPERMATORRHEA. 



The quack and irregular physician have 
always made much of spermatorrhea, sem- 
inal vesiculitis, seminal emissions, varico- 
cele, lost manhood and the various other 
fanciful names by which the one and same 
thing is known. The wonderful treatment 
for this trouble given by the advertising 
doctor is a few inert pills and powders, and 
the victim is told to live hygienically, bathe 
the scrotum in cold water, and wear a sus- 
pensory bandage. 

Spermatorrhea and vesiculitis are usual- 
ly but functional disorders and are usually 
of transitory duration. They may, how- 
ever, appear in a very stubborn form, due 
to venereal or other disease or to excessive 
masturbation. There is a psychic element 
in many young men which aggravates even 
a mild case and causes him to think, after 



browsing on highly-colored literature, that 
his "vital fluids" are draining away. Neu- 
rotic sexual cases must be handled with 
care lest they later become neurasthenics 
or morbid and ambitionless. 

The treatment is, of course, on the whole 
psychic. That does not mean that the suf- 
ferer is to be bluntly told that he is foolish 
or that his ailment is only imaginary. Such 
methods drive him to the quack, who be- 
fore bleeding him at least treats him in an 
affable manner. The sufferer should be 
given instructions with regard to bathing, 
eating, sleeping and his manner of living 
in general. 

Damiana was for many years used as a 
"manhood restorer." This remedy is now 
considered inert, or nearly so. Perhaps 
nothing will allay irritation in the seminal 
vesicles and other sexual adnexa so well as 
a full dose or two of bromides in the even- 
ing. Other useful agencies are cimicifuga, 
cannabis indica and asafetida. If the sex- 
ual function needs toning instead of sedat- 
ing phosphorous, ergot, strychnine, nux 
vomica, etc., may have a modicum of value. 
Constipation must be overcome. Tea, cof- 
fee and alcoholics should as a rule be inter- 
dicted. 



SIMPLE EYE REMEDIES. 



Better judgment with regard to the use 
of eye remedies now exists than did a few 
decades ago, when nitrate of silver, sul- 
phate of zinc and other strong astringents 
and irritants were recklessly employed. 
Boric acid and saline solutions are now 
used more frequently than all other local 
remedies in case of conjunctivitis or in- 
flammation •of the external ocular struc- 
tures. These two bear a greater analogy 
to the tears than any other agencies. 

Hot water antisepticized with boric acid 
is a most valuable agency for lavaging al- 
most any type of ocular inflammation. And 
heat to an inflamed eye should be in the 
manner of a lavage. Heat in the form of 
a poultice will nearly always add to the 
gravity of eye troubles. Cold judiciously 
employed will often accomplish good re- 
sults. Above all else simple eye inflamma- 
tions demand rest and protection from the 



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THE MEDICAL SUMMARY 



light. This is also true of graver inflam- 
mations, plus special ophthalmic treatment. 

Cocaine should not be used for an ex- 
tended length of time, as it dilates the pupil 
and roughens up the epithelial coat of the 
eye. Weak solutions of morphine and cam- 
phor exert a soothing and sedative effect. 
Sulphate of zinc may be safely employed 
as an astringent in a strength of not more 
than one grain to the ounce. Alum and 
tannin solutions are about equally effective 
and may be used with greater freedom. 
Lead solutions may cause damage if there 
is a crack in the sclera. It is doubtful 
whether lead is ever of any value in eye 
affections, anyway. 

The writer has employed with success in 
certain cases a proprietary which contains 
morphine, sulphate of zinc, bichloride of 
mercury and boric acid. For blepharitis 
marginalis a yellow oxide of mercury, two 
grains to two drams of vaseline, is service- 
able. In case of bums from lime or other 
escharotics a lo per cent, ointment of boric 
acid introduced between the lids aids in 
preventing sepsis and in promoting the 
healing prociess. 



OIL OF TURPENTINE, 

This is an old-fashioned remedy that has 
waned in popularity in recent years, yet 
nevertheless one that will in experienced 
hands always exert certain therapeutic re- 
sults. It is especially a valuable remedy in 
passive hemorrhages and those dependent 
upon perverted mucous membranes. Many 
clinicians of wide experience do not hesi- 
tate to give it in aperient doses — two 
drams to a half ounce, and even more — in 
cases in which turpentine seems to them to 
be indicated. It is claimed that the greatest 
force of these large doses is exerted upon 
the intestines, and very little renal irrita- 
tion can come from them. Small doses of five 
or ten minims are said to seldom have any 
untoward effects upon the kidneys, but that 
it is the" medium doses of thirty, to sixty 
minims that are more likely to produce this 
form or irritation. 

Purpura hemorrhagica is the field in which 
turpentine is peculiarly indicated and most 



observers state that it must be given with a 
free hand if salutary results are expected. 
One observer states that in healthy, full- 
blooded children of ten or twelve years he 
gives as much as one-half ounce of turpen- 
tine with an equal part of castor oil night 
and morning, with excellent results. It is 
rather the concensus of opinion that in pur- 
pura turpentine should be given to the 
point of getting purgative results. 

In hemophilia, hemoptysis, and nearly all 
hemorrhagic conditions of constitutional 
origin turpentine is as likely to prove sen- 
iceable as any internal remedy. It could 
not be expected to exert any influence upon 
uterine hemorrhage, unless possibly as a 
styptic. As an intestinal antiseptic turpen- 
tine ranks high. In small doses it is useful 
in flatulent colic and unhealthy states of the 
intestinal mucous membranes. In colicky 
conditions of both adults and children tur- 
pentine exerts a good influence and should 
be given with castor oil; if more anodyne 
effects are desired it should have codeine 
or chlorodyne incorporated with it. In 
hiccough ten drops of turpentine with thirty 
of nitrous ether in aromatic water will usu- 
ally be successful. 

Turpentine is said to exert a favorable 
action on the hepatic function and to cor- 
rect the tendency toward the formation of 
gallstones. Its action here could hardly 
be expected to be more than a corrector of 
inflamed mucous membranes in the hepatic 
mechanism. Turpentine is a reliable an- 
thelmintic against threadworms and may be 
employed internally and as an enema. The 
old method of using it as an enema was 
diluted with barley water or a thin gruel. 



Reports of interesting cases are always 
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Before prescribing for any pharyngeal 
or laryngeal affection make a thorough ex- 
amination of anterior and posterior nares 
and naso-pharynx. 



There is hardly a successful doctor of 
the present age who would not shock his 
grandfather beyond words by the innova- 
tions he has adopted and employed success- 
fully. 



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THE PRACTICAL APPLICATION OF £L£C- 

TRiaTY AS A THERAPEUTIC AGENT. 

FARADIC CURRENT. 

By J. R. Etter, M.D. 

BDITOBIAL KOTE.— This ii tbe fourth of Dr. 
BtUr 8 Mrtes of ihort, praetlcal artldeB. Each 
urtielo will be complete in itself; the entire 
series, when complete, will form a regular 
vatU-meeum on "The Practical Application of 
Electricity as a Therapeutic Agent." These 
articles will be something dllferent, that is. 
they will be presented in a different form from 
the general ran of matter hitherto brought out 
on the subject In the books. No general prac- 
tltion er ca n afford to miss a single number of 
THE 8XJMMABT containing this Series, which 
will run through all the present year and prob- 
ably the next, and will give the technique of 
application minus the theory. 



A short article on the Faradic current 
might not be out of place. This current, 
although perhaps the oldest current that 
has ever been used in medicine, is as little 
onderstood by the ordinary physician, and 
I might say even by some good writers, as 
any other current. The current was nam- 
ed, probably, after its discoverer, Faraday, 
consequently is called the Faradic or in- 
, duced current. The reason it is known as 
the induced current is that it has no direct 
connection with the battery current; but 
the current, generated by the battery and 
carried around the primary coil, "jumps," 
as it were, through a di-electric or insulated 
substance onto the coil of wire known as 
the secondary coil, and it is from this sec- 
ondary coil that the induced current is ob- 
tained. The "primary induced" current is 
spoken of by a number of manufacturers of 
electric apparatus, as well as by various 
writers, but it is utterly impossible to har- 
monize the two expressions, especially 
when they are intended to mean one cur- 
rent The primary current that passes 
into an induced coil is of very low voltage 
*nd tiic quantity is considerable, just in 
proportion to the number of cells used in 



165 



the primary circuit. The secondary cur- 
rent — ^that is, the induced current — is of 
very high voltage which is in proportion to 
the number of ampere turns on the pri- 
mary coil as compared with the ampere 
turns on the coil, and the voltage on the 
secondary coil can be easily figured out If 
one knows the voltage given off from the 
primary coil. This figurement we deter- 
mine entirely on the comparison as between 
the size and number of ampere turns of 
wire on the secondary coil and the size 
and number of ampere turns of wire on the 
secondary coil, at the same time taking into 
consideration the greater distance from the 
primary coil that the outer layer of the 
secondary coil are. The thinner the sec- 
ondary wire is, as compared with the pri- 
mary, and the greater the number of am- 
pere turns, the higher the voltage will be; 
so that one can readily tell just what the 
voltage of a secondary current will be, if 
he knows the voltage, the size of wire and 
number of ampere turns of the primary, and 
the size of wire and number of ampere 
turns of the secondary. The primary cir- 
cuit is a primary circuit, and can be noth- 
ing else, the secondary or induced circuit 
cannot possibly be a primary circuit. So it 
is misleading to speak of a "primary in- 
duced" circuit. 

In the consideration of the subject of the 
voltage of the secondary or induced cur- 
rent, the soft iron core which is placed 
inside of the primary coil, acting as a con- 
denser, would enter into the calculation. 
An induction coil is almost the inverse of 
the transformers that are used on light 
circuits and on electric railway circuits. 
In the latter circuits, the current is trans- 
formed from a very high voltage to a 
lower voltage, while in the Faradic it is 
transformed from a lower voltage to a 
higher voltage. Some writers speak of ^ 
the amperage of the Faradic or in^ueed cur- j 

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THE Medical summary 



rent as varying to a great extent, but I 
think that at the present time no instrument 
has been devised that would measure to 
any certainty the Faradic or induced cur- 
rent as given off by the machines of the 
present day. It might be said that the 
quantity of a Faradic or induced current 
need not be taken into consideration in the 
treatment of diseases with this current. 
While it is held that this secondary cur- 
rent is an alternating current, yet there is 
a certain polarity, — especially to the sen- 
sory nerves. In placing the electrodes on 
the patient, one will be much more sensi- 
tive to the skin, and even contracts mus- 
cles more than the other. Why this should 
be, I am unable to say, but that it is a fact 
is beyond dispute. 
Crawfordsville, Ind. 



DYSENTERY AND SUMMER DIARRHEA. 

^ By W. D. R. Kirk, M.D. 

The case of dysentery presenting a full 
white or dirty white tongue should have 
epsom salts to free elimination. Combine 
it with anodynes in small doses, and it 
will in many cases resemble in its action 
the "Old Sampson" for this latter pur- 
pose. The following, after many hundred 
trials, has proven best of any combination 
known to the writer: 

^ Chloral (sat. sol.) 5j. 

Tine, gelsemium 5iv 

Paregoric q.s. ad. Jviij. 

M. Sig. — From a half to a teaspoonful 
from two to four hours. 

Add a third in bulk of charcoal to the 
salts, grind them in a mortar until thor- 
oughly mixed and give a teaspoonful with 
a half teaspoon of chloral mixture every 
three hours until the bowels act thoroughly, 
after which omit the salts and give a tea- 
spoonful of the latter every two to four 
hours, or repeat according to tormina, 
tenesmus, &c. 

This plan will relieve all uncompli- 
cated cases. Should the characteristic dys- 
enteric actions return do not try to re- 
lieve them by increasing the anodyne, but 



give less of it and combine it with the 
salts again until the actions show that the/ 
are from the salts — cbangwl in color. 

The epidemic form of the disease has 
a fever of the adynamic order and should 
be treated very much like that of typlio-d 
fever. The small dysenteric actions shouM 
have our careful attention, but they do not 
sway the treatment much. In other words, 
treat the pathological condition regardless 
of the tormina and dysenteric discharges. 
These cases are supported and caused by a 
zymotic, a blood poison that must be 
reckoned with from its incipiency, and if 
we have mastered the expressions of 
disease to a good extent we will be quite 
at home in treating the epidemic form as 
well as the sporadic variety. 

About twenty-five years ago the epidemic 
form paid this country a visit and, although 
it was not as fatal as it had been in pre- 
vious years, it was certainly something very' 
much to be dreaded. The fever continued 
without intermission for from twenty to 
twenty-two days, and during the whole 
time scarcely an hour pased without a 
dysenteric action from the bowels, and the 
characteristic tormina and tenesmus. While 
many cases proved fatal, the writer did not 
have one fatal case to his credit. The 
pulse was generally small with strength 
for which tinct. aconite was given, com- 
bined with the indicated zymotic medicine, 
which was often baptisia. Some cases 
had a full, dirty white tongue; they had 
sulphite of soda. Ipecac in small doses \\'as 
given in all cases in which there were 
mucoid discharges. Quite a variety of 
remedies were tried, because "they had 
been found to be good in other cases," but 
nearly every one failed to give any relief. 
Laudanum and starch water promised to 
give more or less relief by enema, but 
could not be retained. In all cases pre- 
senting the flushed face, bright eyes, &c., 
had gelsemium, the dull, expressionless 
face, dilated pupils, and cold extremities, 
were treated with belladonna. Some relief 
was given by using laudanum liniment over 
the abdomen, followed with light peach- 
tree poultices. No diet was called for and 
none was advised, except an occasional 
spoonful of some weak fluid. The full tongue 
of atony was relieved with small doses of 



THE MEDICAL SUMMARY 



167 



quinine and camphor. The cases that re- 
sembled cholera infantum — ^very little 
blood in discharges — were given mono- 
bromate of camphor in small doses trituated 
with sugar of milk. Those cases with a 
fever that intermitted, were treated as 
other intermitants, adding gelsemium or 
Dover's powder. The case in which the 
mucous membrane of the colon sloughs off 
are very tedious to manage and require 
good judgment about the indications for 
remedies, especially those that are ex- 
pressed by the various shapes and colors of 
the tongue. Should that be slick — ^thc mu- 
cous membrane destroyed — such remedies 
as baptisia echofolta, Donovan's solution, 
nitrate of silver, ergot, nitric acid, &c., 
should be prescribed. But if such cases 
present a lead-colored tongue not de- 
nuded of mucous membrane, the iodide of 
potash becomes the leading remedy. I do 
not know why it is, but papine gives better 
results in cases of denuded tongue than 
any other preparation of opium. The case 
presenting the contracted red tongue 
should have hydrochloric acid in pleasant 
sour drinks and grape wine as a stimulant. 
The long continued case that is disposed 
to sink with cold extremities after twelve 
at night should have quinine by inunction — 
a teaspoonful every three hours for about 
three times, beginning at about eleven to 
twelve o'clock P.M. A clear hemorrhage 
with pale tongue and mucous membrane 
will be relieved with carboligen trituated 
with sugar of milk. 

The little teething child with cholera in- 
fantum requires deep thought and atten- 
tion. Those whose bowels act often with 
but little if any effort or pain, cool ex- 
tremities, expressionless, bloodless face, pu- 
pils dilated and eyes half closed, should 
have belladonna in small doses often 
repeated, and tannin in form of proton, 
and if the tongue is in any form of white 
coated, some alkaline antiseptic (for which 
glyco-thymoline is very good), should be 
given. This, too, will be benefitted by 
small doses of monobromate of camphor. 
These extremely fatal cases go down some- 
times for want of cod liver oil, or fats in 
other forms. Therefore, while the writer 
is unable to give the leading symptoms that 
call for it, we should try cod liver oil in such 



cases as above described. I had a case 
that had gone to a very low condition, 
after treating it on every plan that prom- 
ised relief without arresting the disease. 
It was given some fat, fresh hog's meat 
that had been thoroughly boiled, which 
seemed to be all that was needed for a cure. 
It would have been relieved with cod liver 
oil. Another with dysentery, "given up" 
by the attending physician, called for a 
slice of "streaked" bacon, which gave im- 
mediate relief. What symptoms call for 
fats? 
Shuqualak, Miss. 



SOME SUMMER REMEDIES AND THEIR 

INDICATIONS. 

(FOURTH ABTIOLB.) 

By H. Hamilton Redfield, A.B., M.D, 

Professor of Therapeutics in The Bennett Medical Colleger 
Medical Department of The I^ola University, 
Chicagro, 111. Chief Therapeutist to The Jef- 
ferson Park Hosiptal, Chicago, IlL 

AscLEPiDiN. — ^Asclepidin is a concentra- 
tion from asclepias tuberosa. Common 
name, pleurisy-root, butterfly-weed. Hab- 
itat, the United States. Dose of the stand- 
ard granule, 1-12 grain. 

Physiological Action.— Asclepidin acts 
on the tissues and is productive of rheu- 
matic symptoms. It is a diaphoretic, di- 
uretic, laxative tonic, a carminative and ex- 
pectorant. 

Therapeutics. — Asclepidin is most use- 
ful in those cases of pleurisy where the 
pains are acute, the expectoration is scanty, 
or a dry hacJking cough is present. A 
feeling of tenderness can be demonstrated 
near the sternocostal articulations in the 
intercostal spaces, and every breath causes 
excruciating pain. 

In the subacute cases of rheumatic peri- 
carditis characterized by a pain in the re- 
gion of the left nipple, which sometimes 
radiates to the shoulder and is made worse 
by deep inspiration, asclepidin affords 
prompt and marked relief. 

Dysentery and diarrhea occurring in the 
autumn, also subacute mucous enteritis, re- 
ceive benefit from this remedy. 



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THE MEDICAL SUMMARY 



Diarrhea, wJiich is preceded by a feel- 
ing of discomfort in the abdomen, with 
gaseous rumblings, call for the exhibition 
of asclepidin. 

Compare its action with that of rhus 
toxicodendron, macrotin and bryonin. 

Atropine. — The official alkaloid of atropa 
belladonna (common name, deadly night- 
shade), a European plant of the natural 
order of solanaceae, and which contains 
in addition to the official alkaloid atropine, 
the alkaloids belladonnine hyoscine, hyos- 
cyamine, and atropine; also a coloring 
principle called atrosin. Dose of the 
standard granule of atropine, 1-250 grain. 

Physiological Action. — ^Atropine has 
been classed as an irritant, narcotic, my- 
driatic, antispasmodic, and anodyne. In 
small doses it produces stimulation of the 
cardiac apparatus as well as of the respira- 
tory and exerts a stimulating effect upon 
the spinal cord. In large doses it paral- 
yzes the endings of the secretory nerves 
and stimulates the sympathetic system. 

Applied locally, atropine diminishes the 
sensibility of the sensory nerves, and when 
absorbed it produces systemic effect. 

Administered internally, it checks the 
secretions of the mouth, nose, throat and 
larynx, thereby producing a dryness of the 
mucous surfaces, due to the paralyzing ac- 
tion of the drug on the peripheral nerve- 
endings. At first it lessens the gastric and 
intestinal secretions, but its later action is 
to produce a profuse secretion from the 
gastric and intestinal mucous membranes. 

Under atropine the heart is at first 
slowed, but later the heart action becomes 
very rapid and the force is augmented, the 
pulse grows exceedingly rapid, arterial 
tension is high and the circulation is in- 
creased. The action of atropine is brought 
about by its paralyzing action upon the in- 
tracardiac ganglia, thus lessening inhibi- 
tion. It differs from digitalin, inasmuch as 
that drug increases both. 

The entire vasomotor system is stimu- 
lated at first, but afterward, by overstimu- 
lation, it is paralyzed. The beat and force 
of the heart grow weaker, the blood-vessels 
relax and lose their tone, with the result 
that blood pressure undergoes a marked 
fall. There is complete motor paralysis, 
delirium, coma, and finally death due to as- 



phyxia. This when lethal doses have been 
taken. 

The exhibition of atropine, either locally 
or internally, cause dilation of the pupils, 
which is produced by stimulating the end- 
organs of the sympathetic and by par- 
alyzing those of the motor oculi, which has 
the effect of decreasing the influence of the 
circular fibers, while at the same time it 
increases the power of the radiating fibers 
of the iris. Atropine also has the power 
of paralyzing accommodation and lessen- 
ing intraocular pressure. According to 
Donders, the smallest quantity of atropine 
that will produce any effect upon the pupil 
is one-seven hundred thousandth of a 
grain (gr. 1-700,000). 

Large doses of atropine produce cere- 
bral congestion, characterized by a busy 
delirium, which is frequently accompanied 
by visual illustions. 

The region of the spinal cord between 
the second cervical and tenth dorsal ver- 
tebrae is stimulated, producing thereby a 
paralysis of the motor nerves, central and 
peripheral, power in the lower extremities 
being lost first. 

There is a slight impairment of sensi- 
bility, but the irritability of the muscles is 
not affected. The respiration is increased, 
and there is a rise of temperature. 

Sometimes the exhibition of atropine is 
followed by a diffuse scarlet eruption on 
the skin and fauces which greatly resembles 
that of scarlet fever; there is great diffi- 
culty in swallowing and the throat is sore. 
This effect is due to the congestion of the 
capillaries and the consequent greatly in- 
creased circulation. 

Therapeutics. — Persons of a bilious, 
lymphatic or plethoric disposition; women 
and children of a delicate skin; those who 
are happy, jovial and good entertainers 
when feeling well, but who become peevish, 
violent, delirious and subject to convul- 
sions when indisposed, seem to be especially 
susceptible to the action of atropine. 

They take cold easily, and are especially 
sensitive to drafts of cold air; men who 
take cold after having their hair cut 
There is, generally, headache of a throb- 
bing nature. The pains come on suddenly, 
remain only a short time, and leave as sud- 
denly as they come, without any apparent 



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THE MEDICAL SUM.MARV 



169 



caubc v\rhatever. The face is red and 
swollen, eyes are congested and injected, 
pupils dilated and staring. The carotids 
pulsate and the pulse is full and bounding, 
with the mucous membranes of the throat, 
nose and mouth hot and dry. 

Atropine should be studied in all motor 
disturbances, when there is a condition of 
anesthesia, or owing to the great irritability 
of all the senses there is present marked 
hyperesthesia. The muscles jerk or 
twitch, conditions often met with in puer- 
peral convulsions, the spasms of infancy, 
epilepsy, hydrophobia, chorea, whooping- 
cough, and locomotor ataxia. 

Atropine occupies an honorable place in 
those mental disorders characterized by 
marked alterations in the moral tone of the 
individual — hallucinations, melancholia and 
rage, with illusions of a spectral nature. 

In the congestive delirium which fre- 
quently attends the acute fevers or which 
is due as a result of metastasis of the 
brain, atropine is the remedy of choice. 

Cases of congestive vertigo are relieved 
by atropine. It also relieves congestive, 
neuralgic or nervous headaches, when the 
face is flushed, eyes are injected, the lids 
show ptosis, head feels as though it were 
on fire, or the patient may complain of a 
sensation of blindness, or again, there may 
be flashes of light which dart back and 
forth across the eyes. Here the headache 
is made worse by light, noise, moving or 
on lying down. 

The place of atropine in the treatment of 
arterial congestion of the brain has been 
firmly fixed. 

In the hyperemia of sunstroke it has but 
one peer, and that is glonoin. 

The congestions met in cases of injury 
to the head, when there are present all the 
evidences of concussion, congestions 
brought on by great mental excitement or 
excessive indulgence in alcoholic bever- 
ages are promptly met by atropine. 

It should be studied in neuralgia which is 
of recent origin or which occurs in young 
patients, especially when associated with 
hyperemia and hyperesthesia. The pains 
arc generally most pronounced about five 
in the afternoon, coming and going quickly, 
and are made worse by motion. In these 
cases, it will be found, as a general rule, 



ihat the trigeminus is the nerve most af- 
fected. 

In iritis and other conditions of the eye 
it gives excellent results. 

The dryness, soreness, painful degluti- 
tion, swelling, and burning sensation seen 
in pharyngitis and chronic tonsillitis are in- 
dications which call for the exhibition of 
atropine. 

In all congestions and inflammations of 
the uterus, when the patient comi.lains of a 
violent burning sensation with nettle-like 
pains and a feeling of fullness as though 
the uterus were pressing down toward the 
vulva, atropine should be studied. 

Its position in the treatment of fevers is 
between aconitine ajid arsenic. The type 
of fever is usually continuous. In these 
cases the face is red and congested, eyes 
are bright and glistening, and the other 
general indications for the exhibition of 
atropine are present. In puerperal fever 
the exhibition of atropine is imperative; 
also at the onset of scarlet-fever or measles 
when the skin is hot and glistening. In the 
Sydenham type of scarlatina atropine is 
said to have a modifying influence on the 
course of the disease. 

It has been used to good effect in jveri- 
tonitis when the transverse colon cain be 
felt like a pad. There is soreness in the 
entire abdominal region, and the tenderness 
is so great that even the jar of a person 
walking across the room disturbs the pa- 
tient. 

A dry cough with the sensation of a 
feather in the larynx, worse at night, calls 
for atropine; although cicutine should be 
remembered in these cases. 

In pleuropneumonia, after bryonin has 
completed its task and there remains an 
extreme and disagreeable soreness in the 
side, atropine will be found effective. 

In mastitis, when the gland is hot and 
red, hard and heavy, the face flushed, eyes 
are injected, pulse is full and bounding, 
head throbs, and there is an intolerance to 
light, atropine is of greatest service. 

622 W. 71st St., Chicago, 111. 

l.To be Coptinued.) 



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170 



THE MEDICAL SUMMARY 



AN EVERY-DAT PHILOSOPHER. 

By B. a. Souders, M.D. 

Every doctor who has been in general 
practice many years, can recall one or more 
characters among his acquaintances whose 
peculiarities and eccentricities made an 
indelible impression on his mind. 

Distinct in my memory, often recurs the 
picture of a remarkable old gentleman, 
now dead nearly a score of years. Gifted 
with great mental power and a forceful 
and original thinker, he was, by occupation 
only a common plasterer, and in just mod- 
erate circumstances.. Nevertheless* he 
read widely along scientific lines, espe- 
cially medicine, chemistry and allied sci- 
ences. His deductions and theories were 
intensely interesting to me, then a beginner 
in practice. 

Here are a few of his theories : He con- 
tended that the marriage ceremony should 
be performed only by medical men, and so 
restricted by the physical condition of the 
contracting parties that the race would 
constantly be tending to mental and physi- 
cal improvement. Not such a bad idea, 
was it? 

Another thought of his, that has fre- 
quently been a great benefit to me, was 
this: When in dealing with our fellow 
humans we are at a loss to know just what 
step to take in some puzzling or delicate 
position, just stop long enough to change 
places, mentally, with the one with whom 
we are dealing, surround ourselves with 
all his disadvantages, hererity, mentality, 
&c., and then, from that standpoint con- 
sider what would please us under those 
modified circumstances. My old friend 
contended that we poor human creatures 
are actuated by almost the same thoughts, 
feelings and desires, when surrounded by 
the same conditions. 

Shortly after I had introduced the little 
lady who had just promised to "obey" me, 
to the old philosopher, he asked me if I 
had ever observed physicians' wives were 
almost invariably pretty, while the wives 
of ministers of the gospel were usually 
plain. He gave as the reason that doc- 
tors were concerned with the physical part 



of humanity, and naturally were attracted 
by beauty of face and figure. Per contra, 
the minister was dealing with the spirit- 
ual side and disregarded the external. 
What do the brethren think of the idea? 
My personal observation has been that all 
the doctor's wives I have met, had more 
than the average of good looks, but had, in 
addition, exceedingly sweet and lovable 
dispositions. 

Winterset, Ohio. 



SCIENTIFIC THERAPEUTICS. 

By George L. Servoss, M.D. 

The diagnostician has been classed 
among the scientists, as has the pathologist 
and physiologic chemist, but the therapeu- 
tist has always been considered a "rank 
outsider." Although he has been a neces- 
sary evil in the practice of medicine, he has 
been given but little credit for any of the 
terminations of pathologic conditions. In 
fact, so little has been thought of drugs, 
and their actions in overcoming pathologic 
conditions, that they have been given but 
scant attention until very recently. In spite 
of the fact that the laboratory has long 
been used in the perfection of diagnosis, 
but little was ever thought, until very re- 
cently of employing in connection with the 
treatment of diseases. 

Of course, many drugs have been given 
attention by the laboratories, but rather to 
note their perfections, or imperfections, 
than to determine their therapeutic values. 
It has only been within the past few years 
that treatment has been directed in any 
way by laboratory experiment or test. It 
was thought that if the diagnosis was veri- 
fied in this manner that was all that was 
absolutely necessary and that the doctor 
having a case under observation could then 
be guided by such signs or symptoms as 
might arise from time to time. To-day we 
find a decidedly diflFerent condition exist- 
ing. We find the physician relying more 
and more upon the pathologist and physio- 
logic chemist in determining just what 
remedy to employ and how much or how 
little of that agent to use. 



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No one would consider a case of syphilis 
absolutely cured without a negative Was- 
sernian. A very few years ago if there 
were no farther manifestations of the dis- 
ease, after a prolonged treatment, it was 
pronounced cured. Many such cases have 
come under the observation of the members 
of the profession at later dates, bearing 
tertiary or other manifestations and with a 
positive Wasserman, and have been treated 
until such test became negative and re- 
mained so indefinitely. 

With the recognition that toxemia, or 
autotoxemia played a considerable part in 
the causation, or in some instances the ter- 
mination of the vast majority of diseases, 
the laboratory again not only became a use- 
ful agent in the verification of diagnosis, 
. but as well in the direction of treatment. 
Before the employment of chemical, or 
other, tests for the determination of this 
condition, drugs were given in a haphazard 
method, reliance being placed in the signs 
and symptoms as a guide in the treatment. 
To-day we find the doctor making daily 
tests in such cases and frequently varying 
his treatment from day to day, based upon 
his laboratory findings. 

Only recently, in one of the leading jour- 
nals appeared an article upon death and its 
causes, and it was pointed out that, in the 
vast majority of instances death was not 
due directly to the disease under treatment, 
but to some associated condition. He point- 
ed out that the terminal stage of pneumonia • 
was genuine heart failure; of cancer, tox- 
emia of one sort or another, due to inter- 
ference with one or more of the vital func- 
tions; diabetes from profound toxemia, in 
a large measure due to acetonemia ; Bright's 
disease from uremic poisoning. Other dis- 
eases were cited in which the termination 
was shown to be due to other than the 
pathologic conditions of the disease itself. 
If all diseases were treated simply accord- 
ing to the absolute pathologic conditions of 
the disease per se and other concurrent 
conditions were not considered, it is readily 
apparent that failures would occur in the 
vast majority of instances, and this is prob- 
ably one reason why therapeutic agents in 
general have been pronounced worthless. 
It is only within recent years that these 
associated conditions have been given more 



than passing attention, and more especially 
in association with the laboratory direction 
of treatment However, with the recogni- 
tion that other than the classic conditions 
of the disease under observation played an 
important part in the termination, the lab- 
oratory has been called upon more and 
more to make tests for conditions other 
than those usually associated with the dis- 
eases under observation. 

Within the year it has been my pleasure 
to have under observation several cases 
which, from subjective and objective symp- 
toms were pronounced malaria, but which 
did not submit readily to antimalarial treat- 
ment. As these cases came under my ob- 
servation, I suspected toxemia and made 
tests to determine whether or not such a 
condition existed, and in the majority of 
cases found that it did. These cases were 
taken entirely off antimalarial treatment 
and remedies which favored elimination 
were substituted. Daily tests were made 
of the urine to determine whether or not 
there was hyperacidity, of if indican was 
present. These tests not only assisted me 
in determining my diagnosis of the condi- 
tion, but in addition directed the line of 
treatment. With a decrease in the acidity, 
the alkaline treatment was decreased and 
with decrease of indican the eliminatives 
were either decreased or withdrawn. This 
enabled me to apply therapeutics in a scien- 
tific manner and without guessing either as 
to the effects or results. Every patient so 
treated showed steady improvement and 
ultimate recovery, whereas under the pre- 
vious treatment, which was practically 
wholly empiric, little if any improvement 
was noticeable. 

Only recently a case of profound anemia, 
following recurrent hemorrhages came un- 
der my observation. While it was apparent 
without laboratory test that the anemia was 
present and that iron was indicated, as well 
as arsenic, blood counts were made from 
time to time. The cacodylate of iron com- 
pound was employed in this case, the initial 
dosage being one c.c. twice a day. As the 
blood counts showed improvement the doses 
were reduced from two per day to one, 
then one every other day, and finally when 
the count reached practically normal, the 
remedy was withdrawn entirely, the con- 
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elusion being made that the patient would 
obtain sufficient iron from his diet to be 
sufficient to supply any slight deficiency. 
Had it not been for the laboratory tests in 
this case it is very probable that more of 
the remedy than was absolutely necessary 
would have been given and that it would 
have been employed over too long a period. 
This patient was to submit to surgical in- 
terference and not only did the laboratory 
direct the mode of treatment of the anemia, 
but likewise was of benefit to the surgeon 
as it guided him in his decision as to the 
advisable time of operation. 

The discovery of the germ as the causa- 
tive factor in disease production has done 
much to place therapeutics upon a scientific 
basis. Prior to the time of our knowledge 
of this factor our modes of treatment were 
almost wholly empiric, if not entirely so. 
To-day, if we do not employ antiseptics, we 
do employ agents which will overcome the 
activity of the germs which are causing the 
disease under observation. A few years 
ago we treated all diarrheas by locking up 
the bowel, thus overcoming the irritation 
for the time being. To-day, recognizing 
the fact that this condition is due to the 
microbic action, we administer antiseptics, 
which are invariably followed by happy, as 
well as speedy, terminations. Only very 
recently has it been found that the major 
portion of all germs produce what are call- 
ed antibodies and that such bodies act to 
overcome the effect of the germs them- 
selves. This discovery was followed by the 
adoption of antitoxins, vaccines and bac- 
terins, which were employed hypodermi- 
cally with good results. Here again has 
the laboratory played an important part in 
the direction of treatment. It has shown 
the presence of the specific germ in the 
beginning and its disappearance in the ter- 
mination, and has directed the application 
of the therapeutic agent. 

From the foregoing it is clearly to be 
seen that the application of therapeutics is 
being rescued from empiricism and being 
placed upon a scientific basis. It is a 
branch of study which has been neglected, 
time out of mind, but one which is being 
shown to be of as much, if not more, im- 
portance than is diagnosis. 

Not only are therapeutics, particularly 



those of drug nature, being found of great- 
er importance by the medical profession, 
but the public is realizing that fact and are 
demanding that more drugs be employed in 
the treatment of the sick. Very few will 
employ the doctor who drags a case along, 
month in and month out, without some sort 
of treatment and some sort of satisfactory 
result. Other schools than the dominant 
one have long since recognized the efficacy 
of drug medication, and they have been ob- 
taining results where those who have em- 
ployed the "expectant" plan have met with 
failure. This has reacted against this one 
great school, as the public at large has 
called more and more upon the other 
schools. The latter have taught therapeu- 
tics with great care, while the former has 
given the subject but passing notice, it be- 
ing considered of secondary importance. 
A decided change is taking place, however, 
and the recent graduate and those to fol- 
low will be well grounded in this important 
branch prior to entering practice. They 
will be taught to apply the laboratory not 
only to the establishment of diagnosis, but 
to the application of treatment. To-day 
we find that, if the doctor would meet with 
success, he must be well equipped with a 
working laboratory, or be in close touch 
with one, in that he may follow every phase 
of the case under observation. If a single 
thing escape his notice he may possibly 
meet with failure, both as to diagnosis and 
treatment. He must have his chemicals, his 
microscope, his blood-counting apparatus, 
his x-ray and his blood-pressure apparatus. 
In fact, no matter if he be miles away from 
the metropolitan centers, he must be as 
well equipped as is his city brother. With 
such an equipment he will become a scien- 
tific practitioner, and will soon find himself 
making diagnoses and successfully treating 
such cases as he has been in the habit of 
turning over to the city specialists. He 
will arise from the ranks of empiricism and 
become a scientific diagnostician and thera- 
peutist. 

Gardnerville, Nevada. 



After opening quinsy abscesses dilate by 
placing closed scissors in wound and open- 
ing wide to get free drainage. 



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A FEW REFLECTIONS. 



By James S. Sprague, M.D. 

Examiner Med. Juris., Trinity University, Toronto, 
1890-4; EzAminer Mat. Med., etc.. Coll. Phy- 
sicians and Surgeons, 1903-7; Author 
Med. Ethics and Cognate Subjects, 
Ideals in Medicine, etc., etc. 



CHEMICO-METRICAL MADRIGAL. 

I know a maiden, charming and true, 
With beautiful eyes like the cobalt blue 
Of the borax bead, and I guess she'll do 
If she hasn't another reaction. 

Her form is no bundle of toilet shams. 
Her beauty no boon or arsenical balms. 
And she weighs just sixty-two kilograms 
To a decidecimal fraction. 

Her hair is a crown, I can truthfully state 
'Tis a meter long, nor curly nor straight, 
And it is as yellow as plumbic chromate 
In a slightly acid solution. 

And when she speaks from parlor or stump. 
The words which gracefully gambol and 

jump 
Sound sweet like the water in Sprengel's 

pump 
In magnesic phosphate solution. 

One day I said, "I will leave you for years," 
To try her love by rousing her fears ; 
She shed a deci-liter of tears, 

Turning brown the turmeric yellow. 

To dry her tearg I gave her, you know, 
A hectogram of candy; also, 
To bathe her red eyes, some HaO; 
She said, "You're a naughty fellow.' 

I have bought me a lot, about a hectare, 
And have built me a house ten meters 

square, 
And soon I think, I shall take her there, 
My tart little acid radicle. 

Perhaps little sailors on life's deep sea 
Will be the salts of this chemistry, 
And the lisp of the infantile A, B, C 
Be the refrain of this madrigal. 

Dear Dr. Sprague: 

It gives me pleasure to send you a copy 
of my ballad of which you speak: "Chem- 



ico-Madrigal." You perhaps may be inter- 
ested in knowing that I wrote this when a 
Senior at Harvard University, in 1873, 
and, as you know, it has had a great vogue.' 
Sincerely, 

Harvey W. Wiley, M.D., 

Chief of the Bureau of Chemistry of the 
United States, Department of Agricul- 
ture, Washington, D.C. 

To this madrigal of our brother who re- 
cently resigned office, after being in the 
limelight for many years, and who will 
become director of the department, "Good 
Health and Sanitation," at Washington 
for Good Housekeeping, (Boston), the 
women's magazine, I add a few scholia 
and annotations more or less in conformity 
with the work of our brother, who in his 
thirtieth year was the author. I may say 
with Locke : "It is beyond the power of hu- 
manity to spend a whole lifetime in pro- 
found study and intense meditation, and the 
most rigorous exacters of industry and 
seriousness have appointed hours for re- 
laxation and amusement Depew has this 
view: That life is full of compromises and 
they are absolutely essential, for no man 
can live unto himself and for himself 
alone." "A marriage (said St. Augustine), 
without children, is the world without a 
sun." Another fact given us by Depew is 
this: "Every profession is a jealous mis- 
tress and requires the best thought and time 
of her votary, but she is a wise mistress 
and knows that the attentions to her are 
fresher if her lover takes recreations and 
vacations." Professor Metchnikoff, in his 
masterly work, "Prolongation of TJfe," 
says: "Man is capable of much, and for 
this reason we hope that we may be able 
to modify his own nature and transform 
his disharmonies into harmonies. It is 
only human will that can attain this ideal." 

These lines of Richard Le Gallienne, ap- 
pearing in Harper's, when re-read, says 
Literary Digest, completely detach them- 
selves from the class of conventional verse 
to which they at first seem to belong: 

All the words in all the world 
Can not tell you how I love you, 
All the little stars that shine — 
To make a silver crown above you. 



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All the flowers can not weave 
A garland worthy of your hair, 
And not a bird in the four winds 
Can sing of you that is so fair. 

Only the spheres can sing of you; 
Some planet in celestial space, 
Hallowed and lonely in the dawn, 
Shall sing the poem of your face. 

Dr. Crane, of Chicago, in "Fermenting 
Thoughts/' writes: *Tf love thoughts are 
going to *kep* and not play havoc within us, 
we must air our hearts often and keep 
them clean, and be on the watch for the 
insistent microbe that dearly loves to mul- 
tiply in a love 'culture.' Clean up or cast 
out every fermenting thought, whether un- 
cleanliness or distrust, the memory of a 
wrong, or the apprehension of disaster.*' 

"Feed your mind on clean, sweet and 
wholesome thoughts. Above all do not in- 
dulge in self-pity, most horrible of all men- 
tal toadstools. "Keep thy heart," said the 
wise man, "with all diligence, for out of 
it are the issues of life." 

Let a man reverence himself, then he is 
not far from believing in God. 

"O what a world of vile ill-favored 
faults look handsome in three hundred 
pounds a year !" says the "Merry Wives of 
Windsor." If so, it is advisable that 
young men with the title of M.D. honorably 
won, and which no king or potentate can 
give, should follow, unless wealthy, the 
wise and praiseworthy example of impov- 
erished knights, dukes, earls and baronets 
who take to their castles and crested bo- 
soms the daughters of millionaire pork 
packers, and others, who, however humble 
their birth, are handsome with diamonds 
and in satins, yet, **love like a shadow flies, 
when substance love pursues ; pursuing that 
that flies, and flying what pursues," for her, 
who, I pray, will pray, "will share my house, 
and hold my heart and take my honored 
name." — "lest, (as Ruth iv., vi., says) I mar 
mine own inheritance. This is from a speech 
of Othello referring to his courtship of 
Desdemona: She swor't in truth 'twas 
passing strange; 'twas pitiful, 'twas won- 
derful pitiful; she wished she had not 
heard it, yet she wished that Heaven had 
made her such a man; she thanked me and 
bade me if I had a friend that loved her I 



should but teach him how to tell my story, 
and that would woo her. Upon this hint I 
spake." Is there cause for wonder. 

If we, who are of learned profession, 
would study the original writings, or even 
the translations of the ancient classical au- 
thors, we would find many instances in our 
researches and pleasing studies, which 
would remind us that many of our to-day 
distinguished scholars are posing as bril- 
liant men and yet are but putting new in- 
terpretations to words given us by schol- 
ars before the Christian era. One fact is, 
as Montaigne tells us: "There is more ado 
to interpret interpretation than to interpret 
things, and more books upon books than 
upon all other subjects ; we do nothing but 
comment upon one another." In brief, 
"we weave the cast-off ideas of bygone 
ages into the garment of languages; and 
by nimble shuttles, and the chemistry of 
time, create a new meaning for words ex- 
pressive of old theories and sentiments." 

Jovenal, the Roman satirist, after the 
age of 60, and during the first century of 
our era, produced his famous satires in 
which he so severely, yet warrantably, 
lashed the vices and follies of the citizens 
of Rome, which are rapidly appearing in 
these our days. I may state that his sat- 
ires are worth the study by moralists and 
students of eugenics, of marriage relation- 
ships, and all social interests of state and 
home. In Satire vi., 175, he says : 

"Who weds the husband whom her purse 

invites. 
Preserves, unchallenged, all her spinster's 

rights." 

That many true illustrations of this say- 
ing can be presented to-day, is evident 
Bums writes: "I got my death from two 
sweet een, two lovely een o' bonny blue, 
'twas not her golden ringlets bright; her 
lips like roses wat wi" dew, her heaving 
bosom, lily white — it was her een sac 
bonny blue." The words of James Whit- 
comb Riley are: "Her face and brow are 
lovelier than lilies are beneath the light of 
moon and star, that smile as they are smil- 
ing now . . . 

So luminous her face and brow, the lustre 
of their glory shed in memory even blinds 
me now." 



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i7S 



Madame Sylva sang : "Tis the melody of 
love, the sweetest one of all, like the coo- 
ing of a dove, as the evening shadows fall. 
Every heart that beats below, every bird 
that flies above, knows the sunny, and 
serious, sweetly delirious song of love." 

The moral of this contribution is: "As 
ye sow, so shall ye reap, for one cannot 
gather figs of a thorn tree nor grapes from 
thistles." 

Dean Walter T. Summer, of the Cathe- 
dral of Saints Peter and Paul, Chicago, 
says: "Beginning with Easter no persons 
will be married at the cathedral unless they 
present a certificate of health from a repu- 
table physician to the effect that they arc 
normal physically and mentally, and hav« 
neither an incurable nor communicable dis- 
ease.*' 

Yes, eugenics and phylogenesis should 
be a study by our profession and the 
nation, and no one should be allowed to 
marry unless duly examined, and by au- 
thority of our profession — not osteopaths — 
Christian scientists, chiropractists, or 
fakirs. We want able men like Dr. Bogert 
in every state and province to assist us in 
the** Great Work," for sterilization is 
cheaper than the building of walls for de- 
generates and the unfits. 

As a donor has arisen with a gift of 
$100,000 to Cambridge University, England 
— and with which to establish a chair — 
the Balfour Professorship of Genetics, it 
is evident that the distinguished A. J. 
Balfour by his writings on this subject, has 
won many admirers and among them the 
giver herein named. If, as Gladstone 
says: "Physicians are to become the future 
rulers of nations," and it appears from the 
study of great reforms that there is truth 
in the words, it becomes us to encourage 
legislation which shall not permit others 
but the physically and mentally strong, 
and vigorous to be sires and mothers — for 
those for whom "planets have toled and 
forgotten suns have burned" — that man — 
God's masterpiece — should and may live 
in order that His great work be accom- 
plished. If our legislators and our medi- 
cal councils are to allow interference to our 
work by permitting baseless cults falsely 
termed medical — our existence, our pro- 
gress, will be slow — the nation suffer and 
our universities disgraced. 



Yes, as IngersoU tells us: "Time runs on 
in sun and shade until the one of all the 
world is wooed and won, and all the lore 
of love is taught and learned again. Again 
a home is built with the fair chamber, 
wherein faint dreams, like cool and shad- 
owy vales, divide the billowed hours of 
love. Again the miracle of birth — ^the pain 
and joy, the kiss of welcome, and the 
cradle-song drowning the drowsy prattle 
of a babe. 

And then the sense of obligation and of 
wrong — ^pity for those who toil and weep^ 
tears for the imprisoned and despised — 
love for the generous dead, and in the 
heart the rapture of a high resolve." 

SOLILOQUY. 

The public press one year since announc- 
ed that our distinguished brother — the au- 
thor of Madrigal — ^had decided "to take 
her there," and not having heard that there 
was "another reaction," and being aged 67, 
it is my wish, and the wish of us all, that 
the "salts of this chemistry" has had its 
"little sailors." Brother, my apology is 
that, in some respects, which Dr. W. H. 
Drummond ascribes in his "The Country 
Doctor" to the old doctor (of my age and 
that of Dr. Wiley, viz., 67 years) : 

"For it*s purty old, ole; ole story, an* he 

always have it wit' heem 
Ever since he come among us on parish St. 

Mathieu, 
An' no doubt he's feelin' mebbe jus' de 

sam' as noder feller, 
So he rader do hees talkin' about something 

dat was new." 

Perth, Ontario, Canada. 



TIME TO OPERATE IN APPENDICITIS. 

In the early hours of an attack, prefer- 
ably the first twelve, insist on operating, 
provided a competent surgeon is to be had, 
and tell the patient that an early operation 
by a competent surgeon is practically safe, 
but that the non-operative treatment is 
safer in any event than operation at any 
time by a surgeon of doubtful ability. — Dr. 
Christian Johnson, MM. 



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THE SYSTEMS OF MEDICAL PRACTICE. 

(That which has been is now.) 

By G. Curson Young, M.D. 

The systems of medical practice are 
many; if all the forms of practice may be 
called systems. Systems implies thought, 
care and interest in the object of the sys- 
tem and order. 

All systems of medical practice are 
based on some form of science and reason; 
even those who practice healing without 
medicine claim a system of science. The 
Eclectic, Homoeopathic, Allopathic, Physio- 
Medical and Bio-chemic are the five sys- 
tems of practice generally accepted at the 
present time, and these are to a certain ex- 
tent, somewhat a confusion and little 
short of a contradiction. For instance, 
homeopathy: any drug which will produce 
the symptoms of a disease in a healthy per- 
son will cure the disease which the symp- 
toms produced indicate. Allopathic, Hetro- 
pathic: founded on differences, by which 
one morbid state is removed by inducing a 
diflFerent one. In the dosage of medicine: 
if the Allopathic would give one grain of a 
drug as a dose, the j^omeopathic dose would 
be a fraction of a grain of the same drug. It 
is dogma in a broad sense in both cases. If 
an Homeopath, or Allopath, professed, in 
their faith, and dogma, should at any time 
trespass on the dogma opposite, they 
have broken faith with the dogma of simi- 
lar similibus and differences, and become 
Eclectic. Faith in dogma may have con- 
siderable effect in matters of religion, but 
not so much in medicine. 

The nucleus of new systems of medi- 
cine have usually been based on the de- 
fects of a former system, either, ineffi- 
ciency of the means used or mode of ap- 
plication caused the failure. 

Morbid diseased condition of the human 
body, or wounds received in conflict with 
man or beast, must have been the first 
cause for the use of the medicine man and 
his remedies, as a mediator or interpreter 
of physical defects. 

It is related in the oldest history of man 
that many of the people lived hundreds of 



years, but they all died, and it is fair to 
suppose some of them died of some disease, 
and most likely under some system of medi- 
cation. The system of medicine adopted 
by the ancient people of the earth was 
largely an intuitive one, very much after 
the manner of animals, such as the horse, 
ox, sheep, dog, cat and others, all of 
which are often seen seeking some special 
herb, root, bark or leaf. Many remedies 
are used by man that were suggested by 
the habit of some animal or by self in- 
stinct. 

The nucleus of man was probably as 
large as the nucleus of the earth, and as all 
things, vegetable and animal were made 
for man, his intuitional comprehension be- 
ing equal to the kingdoms put under him 
whether useful for medicine or food he 
would have a natural instinct in choosing 
both, his fool and medicine. This was the 
instinctive or natural system of medicine. 
This system has sustained its good repu- 
tation against all other systems. 

As far back as we can trace the history 
of man, we find some men with a special 
calling. The functions of the priest, phy- 
sician and teacher or doctor of law, were 
at first united in one profession, and it mat- 
ters not how far we go back, we cannot 
find a people on the face of the earth, 
without a religion or a medicine man 
with a system of practice, and all the tribes 
of earth have ever looked upon the priest 
and the physician as partakers of some sort 
of an occult divination with much influence 
over natural organic laws, which implies 
cause for the established mode in which 
the action and phenomenon connected with 
the laws of growth, health, decay and death, 
which takes place, in both, vegetable and 
animal life. There are as many laws of 
nature as there are relations between dif- 
ferent organic bodies, including man, and 
the perversion of any one law means a 
lower vitality, which is sure to end in dis- 
ease, latent or active, demanding the remedy 
which nature has so carefully provided in 
the system of natural therapeutics, but it is 
left to the educated man to discern the 
right from the wrong; for this purpose 
man is constituted with an inborn intui- 
tion, guided by this, as a physician he will 
found a correct system of practice. 



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^77 



Tliere has always existed a system of 
natural medical practice. Cronos, Chiron, 
Machaon, Podalirus, Asculapius, Hoppocra- 
tes and many others, used herbs, roots and 
'xarks as medicine, we know, since the 
thirteenth century B.C. There is no 
evidence to prove that this system of 
medication was not continued down to the 
time of Pythagoras, 580 B.C. The school 
or college of Crotona, where Pythagoras 
was educated, taught vegetable medication, 
and we have a number of cases in Syria, 
Babalonia and other countries where 
Crotona graduates were called to adminis- 
ter remedies for disease, and in many 
cases it is recorded that the physician, 
after examining the patient went into the 
garden or field and collected herbs for 
medicine. 

Deraocedes, a noted physician of Crotona, 
performed a medical cure of a sprained an- 
kle joint of Darius, King of Persia, 59a 
B.C. He treated and cured a cancer or« 
the breast of Atossa, one of the King's 
wives, and daughter of King Cyrus. Many 
other cases are recorded of cures being 
made by physicions whose system of prac- 
tice and therapeutics consisted in vegeta- 
ble products. The Greeks had allowed the 
practice of medicine to be over-shadowed 
by other sciences, and philosophy, but the 
Persians continued to improve and make 
the science of medicine more perfect and 
useful. The Persians were much exercis- 
ed in surgery, doing many operations with 
great skill and advantage to the patient. 
For reducing inflammations, antiphilogistic 
treatment was largely indulged in by them, 
and it is astonishing how quick wounds 
made by their war and other instruments 
were healed, with the expressed juices of 
herbs and roots. 

This system of practice continued and 
was in use when Hippocrates began to at- 
tract attention. His pathology was of the 
same order, but somewhat better defined, 
and causation of disease brought out in a 
more definite form, physical, chemical and 
structural causes assisted by ythe four ele- 
ments, heat, cold, dryness and moisture; 
also the four humors, "Blood, bile, black 
bile and phlegm." As pathologic indicators 
and setiologic factors, Hippocrates' doc- 
trine was that all diseases proceeded from 



the four elements, the excesses of which 
engendered one or more of the humors 
improperly concocted. This was known as 
"humoral pathology," or system in which 
very little medicine was used, but dieting, 
good conduct and large draughts of in- 
fusion and emulsion of marsh-mallow and 
mandragora. It was not long, before the 
system practiced by Hippocrates was taken 
up by the schools of philosophy, and the 
empirical, theoretical and philosophical 
systems of medicine mixed with pythagor- 
ian philosophy inaugurated a reform in 
habits, hygiene and diet 

From 400 B.C. to the time of Galen, 160 
A.D., Coction, which was understood to 
mean the morbid material of the body and 
the processes it passed through prior to 
its elimination through the organs of ex- 
cretion, thus mixing the morbid matter 
with the humors; then came the cricis — 
The Autiointoxication. 

About this time varied distinctions oc- 
curred between the rival factions of phy- 
sicians and their systems of practice; one 
historian says that not less than a dozen 
among the Latins, Greeks Egyptians and 
Arabians. The Rationalists and Empirics 
were so antagonistic that they denounced 
each other in vile terms. 

The chief cause of dispute was, occult, or 
constituent causes, also their evident and 
exciting causes. The Cnidus School held 
diseases as logical entities always mani- 
festing an essential appearance, and not 
mere accidental groups of symptoms. Thus 
they described seven different diseases of 
the biliary organs, twelve of the bladder 
and four of the kidneys, four kinds of 
stranguary, three of tetanus, four of 
jaundice, three of pulmonary phthisis, and 
four of cancer. 

The doctrine of self-limiting disease an- 
nounced long before this time by Ascle- 
piades, 63 B.C., caus*.d no less than three 
factions, which held in whole or in part 
that disease was like hunger, which must 
be appeased; and the treatment should be 
such as would stimulate a desire for succu- 
lent herbs, such as cactus, ever-greens 
and marsh mallow. 

Herophilus called attention to the pulse 
as being of value in diagnosis. Erasistra- 
tus pointed out the nerves of motion as dis- 



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tinct from the nerves of sensation, and 
Dioscorides in 54 A.D. arranged and pre- 
pared a materia medica. In this work we 
have a distinction and a very proper one. 
A medicament is applied to that which 
heals bodily and mental diseases. Where- 
as remedium is that which aids in the alle- 
viation of pain, ihey said that there are 
remedies for a cold, but no medicament. 
There were even finer distinction than this 
made, which is somewhat remarkable in 
so early an age of an inexact science which 
had endured so many ebbs and flows 

Celsus was the moving spirit of the first 
century A.D. He made an impression as 
a devoted empiric and had a large follow- 
ing. His writings were so effective and 
copvincing that a new system based upon 
his doctrines, was established. Celsus 
claimed the knowledge of causation and 
cure of disease was more important than 
the knowledge of Roman and Greek phi- 
losophy to the physician, if he could not 
obtain them both. "When remedies are 
found then men begin to discourse about 
the reason for their use. For medicine 
was not given in consequence of reasoning, 
but theory was sought for after the dis- 
covery of medicine." On the appearance 
of any new disease the physicion would 
not be obliged to have recourse to occult 
things; he would seek for its resemblance 
to disease already known and meet it by 
remedies analogous to such as had been 
successful in a similar malady, until the 
true (or definite) mode of treatment coula 
be discovered. 

Not that judgment or reasoning is un- 
necessary to a physician, or that an irra- 
tional animal is capable of practicing medi- 
cine, but conjectures which relate to occult 
things are of no use." 

Celsus was guided by experience and was 
an ardent empiric. Unlike Hippocrates, he 
had little or no faith in or use for theory 
and the occult. He believed in the self- 
limitation of disease as taught by Ascle- 
piades, and the communicability of disease 
as taught by Thucydides. Celsus taught 
that all things in nature were subject to 
natural definite laws, and that medicine 
was definite in its curative action, when the 
proper medicine was used, and that expe- 



rience would teach how and when to select 
the medicine for each disease. Although 
Celsus used decoctions he practiced definite 
medication very much after the manner it 
is practiced at the present time. The two 
systems of medication which prevailed were 
the empiric and the pathologic, humoral. 

Galen opposed Celsus by his theoretical 
conclusions, as against Empiricism. Al- 
though Galen did not write definitely on 
medicine, yet his works are to some ex- 
tent expositions of his theories and he 
formulated a number of doctrines and 
largely pursued the same system, with some 
variations, as distinguished Hippocrates, 
whose disciple he was proud to be known. 

Galen is better known for his code of 
medical science, which as one writer says, 
"Possess no great originality, made up of 
the doctrines of his predecessors of every 
sect and disfigured by many incongruities." 
Yet as a whole, this code is remarkable for 
its general imity and consistency, but his 
fundamental doctrines are too often the 
creations of the imagination. 

Galen was a theorist and his disciples are 
with us to-day in large numbers. 

His system of practice was very much 
like unto that of Hippocrates and Areteus, 
to use only a few remedies and never the 
monstrous compounds as used by the 
charlatans of Rome. Evacuants, emetics, 
purgatives, refreshing drinks, diet, faith, 
the keystone, and stimulants, were much 
depended upon. Galen gives us little of 
prescription formula or description of dis- 
ease except the plague, and that is inter- 
mixed with his extravagant verbose to such 
an extent that it is of little or no value. 
This is so unlike Celsus, who, in his fifth 
book under the title of Morbi Medicamentio 
Curandi et Medicamenta has given up- 
wards of one hundred prescriptions, be- 
sides many in the other books. Anatomy 
and materia medica are fully elucidated. 
Galen was a brilliant scholar and his in- 
fluence extended far and wide during his 
life and long afterwards, but we fail to 
find any reason why he should be placed 
above the rank of Celsus, Hippocrates, Are- 
teus and many others, as a physician. 

Washington, N. J. 

(To 1)6 continued) 



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179 



GIVE US MORE OF THE PRACTICAL. 



By George L. Servoss, M.D. 

One can hardly pick up a medical jour- 
nal without running across one or more 
articles which, although somewhat rele- 
vant to medicine, carry nothing of a real 
practical value to the average general prac- 
titioner, more particularly he of the coun- 
try. Page after page is devoted to eugen- 
ics, or some other subject of like nature. 
Such subjects are of more or less value to 
all of the profession, but have no great 
value for the country practitioner. In 
those country neighborhoods where we find 
few jail occupants the doctor cares but 
little regarding the matter of unsexing of 
the criminal, and articles relative to the 
operation therefor are of no practical in- 
terest to him. It is true that every doc- 
tor should assist the educators of the 
rising generations in the teaching of prac- 
tical physiology, in that the children may 
be taught to take better care of themselves, 
but every doctor, if he knows anything of 
psychology, is in a position to give such in- 
struction without being obliged to read 
article after article in the medical journals 
upon the subject of eugenics. 

Of what real value, practically, is an 
article devoted to the subject of diverse 
and how to avoid it? It is probable that 
a great improvement could be brought 
about in the approach of a man to his wife, 
but what doctor is going to interfere with 
family affairs of this sort? How long 
could he carry on such a campaign of ed- 
ucation without getting himself disliked? 
The people do not appreciate efforts of this 
sort, even though they be made with the 
idea of bringing about better social condi- 
tions. It is a noticeable fact that those 
doctors who have interfered with family af- 
fairs, other than their own, have eventu- 
ally either sustained great losses of prac- 
tice, or have been obliged to seek other 
locations. It is well that the people should 
be educated, but it does not seem practical 
that the doctor should undertake anything 
of the sort, unless specifically called upon, 
and even then he should make progress 
slowly. This is a subject which is given 



considerable space in the journals to-day. 
Despite any education as regards proper 
love-making which may be advanced by the 
doctor, I doubt if the divorce courts will 
become any less busy. Leave such matters 
to the preacher, who is supposed to care 
for the spiritual welfare of the people. 
Let the preacher learn „how, when and 
where to do it," and let him give advice 
upon the subject of greater love man for 
woman, or woman for man. He can do 
this without getting himself disliked. 

Instead of devoting page after page to 
eugenics, or subjects of this sort, let the 
medical journals stick more closely to 
medicine and subjects of more practical 
benefit to the profession at large. 

Every day, and more especially since 
the introduction of salvarsin, we see the 
Wasserman test mentioned, but I doubt if 
a single journal within the past year has 
given the technic of this test. Eveiy 
practitioner is supposed to know just how 
to carry a AVa.^serman to completion, but 
I would be willing to wager that manv of 
the older practitioners know absolutely 
nothing of the technic thereof. More es- 
pecially is th's true of those who happen l.> 
be practicing in poor and sparsely popu- 
lated areas, and who have not the means 
which allow of frequent post graduate 
courses. Let the journals give us matter 
of this sort, which will be of practical 
nature. 

In the consideration of typhoid fever 
the question of diagnosis frequently rests 
upon the Widal, but how often and in how 
many journals within the past year, has 
one been given any idea as to how such a 
test should be carried out? Every doctor 
is supposed to know something of this, but 
how many in the wilds could give the tech- 
nic of operation? Would it not be far 
better if the journals were to give an idea 
of how to do either the Wasserman and 
Widal at least once every six months, than 
to ignore these important tests and give 
the space to articles of practically no value 
to the average general practitioner? 

To-day we find the city doctor giving 
much attention to the blood count, both in 
consideration of diagnosis and subsequent 
treatment, but in how many instances do 
you find the country practitioner giving 



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this matter even passing attention? In 
but very few. How many articles regard- 
ing the blood count, both in health and 
disease, have appeared within the journals 
within the past year? I believe that the 
general practitioners all over the country 
would appreciate articles relative to this 
subject, telling them how to make blood 
counts and advising them as to what re- 
lation such counts had to disease. 
Of course the doctor is supposed to know 
these things, but he of the country who 
may not be able to get to a society meet- 
ing, or mingle with those versed in 
modern matters at very frequent intervals 
is not posted relative to things modern. 

We find the insurance companies de- 
manding that all examiners be equipped 
to take blood pressure, and that, in addi- 
tion this is a matter of paramount import- 
ance in the everyday practice of the phy- 
sician, but what journal, if any, has given 
the doctor any article of practical worth, 
upon this important subject. Would it 
not be well tor some one to devote a little 
time to the technic of manipulation of 
blood pressure apparatus, and also give us 
an idea regarding the relation of the differ- 
ent pressures, both in health and disease? 
This should be a subject for discussion in 
the journals at least once every six months. 

Every doctor should have a microscope 
and know how to use it, but how many of 
the older men of the profession have noted 
in the journals any articles relative to the 
handling of this very important adjunct 
to medicine? How many articles relative 
to manipulation within the pathologic lab- 
oratory have been printed within the pages 
of the medical journals within the past 
year? Has any writer ever given us a 
practical article upon the use of the micro- 
scope, telling us of the relations of eye- 
piece to objective, the use of the condens r, 
the diaphragm ; in fact, any of the mechan- 
ics of the instrument? This is a subject 
of practical value to the general, as well as 
the special, practitioner, and one which 
should not be overlooked by the journals. A 
single article a year in relation to the 
physiologic and pathologic laboratory 
would be of far greater value that would 
the articles now appearing upon subjects 
only slightly relevant to medicine. 



The urine, feces, sputum and other ex- 
crementitious substances are now the sub- 
ject of examination, both chemically and 
microscopically, but who, other than the 
skilled pathologists, can make such examin- 
ations? What have the journals had to 
say regarding the technic employed in 
such examination? Is it not true tiiat the 
majority of general practitioners have been 
obliged to send such substances to distant 
cities for tests thereon? Would it not be 
well for the journals to give us an idea, 
and a full one, regarding such tests, in 
that the country doctors might be able to 
carry them out immediately and without 
excessive cost to the patient, as well as a 
loss of time, both to patient and doctor? 
Some little attention has been given to the 
technic of urinalysis, but more space could 
be devoted to examinations of all sorts, 
and I believe that the journals should not 
overlook these matters of great importance. 

A revolution has been taking place in re- 
lation to the application of drugs and their 
application in pathologic conditions, but 
many of the journals still cling to the older 
ideas of medicine and do not give space to 
the consideration of this subject. In con- 
sequence of this the education in the use 
of drugs is overlooked to a very consider- 
able extent, and those doctors who only 
see one or two journals a month do not 
receive the latest ideas regarding the ap- 
plication of drugs. I believe that it would 
be well for every journal to establish a col- 
umn of review of the latest ideas and 
findings regarding things therapeutic and 
give their readers the benefit thereof, even 
though they might devote the major por- 
tion of their space to things of a faddish 
nature. How many of the country p'^c- 
titioners know that it is possible to absorb 
many of the specific infectious diseases if 
the proper remedies are employed eartv 
and pushed to full therapeutic effect? A 
good many, of course, but far too feu 
and the medical journals aie largely '" 
blame for this. Let the journals give 
more space to the consideration of articles 
upon applied therapeutics, even though 
the editors may not agree, in toto, with the 
ideas of the writers. Many a country 
doctor makes discoveries which would be 
of value to the city practitioner, and the 



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tormer should make public, through the 
medical press, all of his findings out of the 
ordinary. Some things, in connection with 
therapeutics, may seem very ordinary, but 
if published it will be found that ideas, 
new to many, will appear. 

Let those journals which are devot- 
ing so much space to fads, drop some of the 
papers devoted to such subjects and give 
the space to matter which will be of more 
general benefit, both to the doctor and his 
patients. 

The medical journal should be an edu- 
cator in things medical, and practically 
nothing else, if it be of practical use to the 
reader, and the latter should demand that 
only practical medical matter be printed 
therein. It is not necessary that the arti- 
cles therein be "*long winded," as it fre- 
quently occurs that a few lines, or even a 
few words, will carry ideas of vast prac- 
tical value to the general practitioner. No 
matter, however, whether the articles be 
long or short, let them be of practical na- 
ture, in that they may be read with profit. 
The medical journal should be retained as 
a reference, but if it contains nothing but 
faddish stuff, it becomes practically worth- 
less after the first reading, and may be bet- 
ter employed as kindling than for any other 
purpose, as it will not serve to fill space 
which should be given to practical refer- 
ences. Let every editor give this subject 
careful and prayerful consideration and 
let us have medical journals at least par- 
tially filled with practical, every-day stuff. 
Gardnersville, Nevada. 



WHAT TO DO FOR GOITER. 

By Wm. M. Gregory, M.D. 

When goiter treatment is mentioned most 
doctors think at once of iodine in some 
form, or else thyroid gland. I did once, but 
I have got something better now, although 
after all it is only an old remedy in a new 
and vastly more efl&cient combination. Sev- 
eral years ago I prescribed for a woman 
who had a large fibrous goiter of long 
standing, and who was suffering from a 
very irritating tracheal cough, probably 
caused by the irritation of the goiter, a pre- 



scription of powders each containing a very 
minute dose of proto-iodide or yellow iodide 
of mercury. I did not see her again for 
about two months, and when I did, was as- 
tonished to see that that hard old goiter was 
about three- fourths gone. That was eight 
or ten years ago, and since that time I have 
followed up the idea, and used the proto- 
iodide in a large number of cases, and I 
wish to say to the profession that in all 
young, incipient, or soft goiters it is prac- 
tically a sure thing. It will do much for 
some very long standing and large goiters, 
and should be given a thorough trial in 
such cases, but the difference lies in the 
fact that you are perfectly safe in promis- 
ing a cure to the young woman with recent 
goiter, even if quite large, when it is not 
safe to do so with old cases with harder 
and more fully organied goiter tissue. A 
physician who has once tried the proto- 
iodide of mercury will never try again to 
reduce the patient's neck by painting it with 
iodine or by feeding her thyroid gland. It 
is always necessary to watch young goiter 
patients closely for anything that might 
cause uterine irritation, as if anything of 
that sort exists it will probably spoil your 
best work done for the goiter. Give the 
patient a prescription containing specific 
gelsemium, cimicifuga, and Pulsatilla, if you 
can detect any uterine disturbance along 
with her proto-iodiue powders. Now, a 
word as to the dose. I have used powders 
containing from i-iu grain of the proto- 
iodide to 1-30 grain. I use what is called 
the 2x or i-ioo trituration of the yellow 
proto-iodide. A ten-grain powder will con- 
tain i-io grain of the drug and a four- 
grain powder will contain 1-25 grain. 
Now, you certainly can get little tablet 
triturates containing any dose you want of 
the drug, but just take my advice, don't you 
do it. For some unexplained reason, a 
very little dose of medicine will produce a 
vastly bigger effect if it is scattered 
through a large powder of some inert ma- 
terial, than it will ii* the form of a very 
minute tablet or pill. I usually give these 
goiter patients a powder every two hours 
for two or three days; then four times 
a day. This proto-iodide is as much a spe- 
cific for goiter as quinine is for malaria, 



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or mercury or potasium iodide is for specific 
disease. 

Berea, Ohio. 



PHASES OF THE MOON AND THE TIME 
OF LABOR. 

By Thomas R. Evans, M.D. 

It usually provokes a smile to speak of 
the eflFects of the moon upon anything than 
upon the water of the ocean. Yet in that 
person who in her phases is so like the 
moon may not the moon produce certain 
rythmical eflFects? But fortunately for this 
little paper, we will not consider causes or 
eflFects, only coincidences. Strangely, ex- 
cept by the astronomer, mariner, and the 
:supposedly ignorant farmer, the objects to 
be seen in space at night have not been 
scientifically utilized. 

It would make this article too long to tell 
of the common use of the north star and 
of the moon to the sailor, or to defend the 
supposedly absurd or not absurd guidance 
in agriculture aflForded the farmer by the 
moon. On the tractless sea the moon is the 
sailor's timekeeper, while on the soil it of- 
ten gives the time for the plantinj. 

By the medical man it can be used as 
the most convenient *'ready reckoner" as 
to the probable time of labor. In daylight 
he can consult the calendar or almanac. 
Indeed, the moon is quite as reliable, if not 
more so, than the tables given for the cal- 
culation of the date of labor, and can be 
used to confirm or to refute the table. If 
the date in the table corresponds with a 
period of the new moon, or its following 
crescent, or with the last quarter or with 
its crescent, it is probably correct. If not, 
the 280 or 285 days may be ignored, as the 
woman has probably given the wrong date 
from which to reckon. The period of the 
full moon may be said to continue for four 
nights, more or less. In September and 
October, in which the harvester and the 
hunter have several days and nights in 
which to work and to hunt, there is but 
little liability of a confinement during a 
week in those months. The late month of 
May gave two conspicuous times of free- 
dom from cases of labor, inasmuch as it 
gave two full moons. 



How did we arrive at this very useful 
and unusual information? We found that 
women are very seldom menstruating when 
the moon is full, and were confirmed in this 
by Landois, a noted foreign physiologist. 
It then followed that women are not liable 
to have babies at that time, for such babies 
usually come "around about" the time of 
a menstrual period. The third menstrual 
period, or what would have been the third 
period had not pregnancy intervened, is a 
noted time for abortions. The tenth men- 
strual period, held in abeyance by preg- 
nancy, is usually the time of labor. 

But these calculations must not be con- 
sidered as exact or invariable. Of course, 
the moon is not full on the same date in 
each month. Its phases change backwards 
and forwards, but it is sufl5ciently constant 
for the sailor in reckoning longitude. So 
no woman is usually menstruating on the 
same date each month, but she is about a> 
regular as the phases of the moon. It 
sounds like barkening back to antiquity, 
but certain functions in woman are un- 
doubtedly coincident with lunar manifes- 
tations. We wrote that we would only con- 
sider coincidents, but we cannot resist the 
temptation of adding, as if in confirmation 
of one of the many alleged causes of labor, 
that the fetus comes out of the uterus to 
make water, the following: Lately I de- 
livered a boy child, and before the cord 
was tied, he delivered a bold stream, and 
the color of it was like that passed about 
noon in the adult; as if he too had eaten 
and worked. Thinking of the old ancients' 
cause of labor, I had to laugh. 

Now, if this article causes more know- 
ledge of the moon than that displayed by 
the man holding on to a lamp post, who said 
that he was a stranger in the town, and 
therefore did not know whether it was the 
moon or the sun which shone, an advance 
will be made. The city doctor is more 
oblivious of the moon than is his country 
brother. From henceforth let them who 
practice obstetrics mix the moon with their 
work, and they will find it both pleasant 
and profitable, and great discoveries may 
be made. Astronomy must not be con- 
founded with or prejudiced by "astrology. 
Broadly, medicine touches all science. 

Huntington, W. Va. 



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ACONITE AND ITS USES. 



Dr. Douglas H. Stewart, of New York 
city, in a late issue of the Medical Standard 
says : I use aconite in fever whenever there 
is a rapid, strong pulse and a dry, hot skin. 
I always use the homeopathic mother tinc- 
ture unless Fm overruled by my confreres. 
The danger of overdosage is exaggerated. 
Five minims in half a tumbler full of water 
and given in teaspoon ful dosage every ten 
minutes is about as useful therapeutically 
as five minims of the tincture three times a 
day. Blueness of the lips and fall of the 
blood pressure are the signs of danger. 
Note tingling of the lips if the patient is 
conscious (this is often missing in typhoid 
fever). I have used aconite in many forms 
of neuralgia, but find it inferior to gelse- 
mium. I have had no experience with local 
applications of the drug. In nervous affec- 
tions I generally prefer gelsemium. Acon- 
ite is also employed in tachycardia — espec- 
ially in the racing heart of actors, singers, 
etc. "Ask yourself," says Dr. Stewart, 
"would this case be helped by bleeding?" 
If so, use aconite. I also use the drug in 
cardiac hypertrophy — i or 2 minims three 
times a day. Have not used aconite exter- 
nally; but injected aconite into a painful 
sciatic nerve. It hurt so badly that pain 
ceased to be a factor in the case ! Did it 
once! The patient begged for amputation 
as a relief. Have had much trouble with 
the preparations of aconite and prefer the 
homeopathic mother tincture because (i) it 
does not act explosively; (2) it acts as I 
expect it to; and (3) I can get it "around 
the comer." It will relieve the painful 
throbbing of peritonitis, but otherwise is of 
little value in that disease. It will stop 
diarrhea, but I do not know why. I rarely 
use it in continued fevers. Aconite is good 
in suppression of menses due to surf bath- 



ing (three cases). Results of aconite sweat 
are good. Have also found it useful in 
cholera infantum in connection with saline 
irrigations. 



AN ANTISEPTIC NASAL OINTMENT. 



Dr. Bourgeois is credited in the Journal 
de Medecine de Paris with the following: 

1^ Balsam of Peru gr. xxiij. 

Wool fat 3iiss. 

Petrolatum 3v. 

M. ft. unguentum; dispense in a tin tube. 

Taken early, as soon as the posterior 
nares are affected, this ointment will abort 
a coryza ; it is also useful in simple chronic 
coryza. In atrophic ozaenous rhinitis, in 
which the membrane is much inflamed, the 
dose may be largely increased. 

Properly to use a nasal ointment the pa- 
tient should lie flat on the back, introduce 
into the nostril the end of the tube, and in- 
hale by repeated short efforts, while press- 
ing the flexible container, until the oint- 
ment is felt to fall into the throat; he may 
then rise and expectorate, when much of 
the adherent mucus will be expelled along 
with the excess of ointment. 



A PERSISTENT CHRONIC COUGH. 

A dry, harsh, hacking cough, with con- 
stant tickling in the throat, or with a sensa- 
tion of burning the in throat and post-nasal 
region, can be cured by dissolving a grain 
of nitrate of sanguinarina in four ounces of 
water and giving a teaspoonful every hour 
or two. Winter coughs may be cured by 
the persistent use of this remedy. — Dr, 
Ellingwood, 



183 



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SUMMER DIASSHEA IN INFANTS AND 
CHILDREN. 



Dr. M. J. Synott, in Archives of Pedi- 
atrics, says: Lactacid tablets are of use in 
certain afebrile and protracted diarrheas 
with tympanites and other evidences of in- 
testinal putrefaction, and adds that sulpho- 
carbolates of soda is a valuable remedy 
also in this condition. 

We are glad to find the value of the sul- 
phocarbolates being appreciated more and 
more, although personally we should pre- 
fer the sulphocarbolates of calcium and of 
zinc in the siunmer diarrhea of infants and 
children, the calcium salt, because this is 
very necessary for the growth of the organ- 
isms, and is apt to be deficient, the zinc 
salt in doses about one-quarter of those of 
the calcium sulphocarbolate, for its as- 
tringent effect. 



trie mucosa, are indicated in the period of 
convalescence, after a severe attack of in- 
digestion. 



GASTRIC CATARRH. 



Acute gastric catarrh, acute gastritis, 
acute dyspepsia, gastric fever, bilious fever, 
is acute catarrhal inflammation of the mu- 
cous membrane of the stomach, character- 
ized by feverishness, loss of appetite, nau- 
sea, vomiting, pain in the epigastrial region 
or discomfort in the abdomen. In severer 
forms they start with a chill and a febrile 
reaction where the temperature may rise 
to 102 or 103. The tongue is heavily coat^ 
cd, vomiting is frequent, containing the be- 
ginning particles of food, later mucus and 
bile. There is constipation, frequently col- 
icky pains and diarrhea. Mild attacks do 
not last very long — a day or two. In the 
severer forms where the gastric mucosa has 
been damaged more deeply and the secre- 
tion of gastric juice reduced to a mini- 
mum, we have got to be very careful in the 
selection of food after the acute symptoms 
have subsided and begin with small quan- 
tities of milk and farinaceaus decoctions 
which call for minor <figestive activity. 
Even at times these foodstuffs are not 
well tolerated, and it is advisable then to 
order them peptonized, to substitute artifi- 
cial digestion for the natural one. A 
course of tonics, stomachics, bitters, which 
stimulate the secretory powers of the gas- 



THERAPEUTIC ABORTION. 

It is a matter requiring in some cases 
almost more than human knowledge and 
insight to know whether it is best to ter- 
minate an unnatural gestation or depend 
on nature to at last work out the case in 
her own time and way. Hyperemesis grav- 
idarum is the one condition that often calls 
for intervention. This distressing affection 
has been divided into three types depcmd- 
ing upon the causes. These are reflex, neu- 
rotic and autotoxic. The latter is the most 
common. 

The one major symptom is continued 
vomiting and the depression and inanition 
that accompany it. Palliative measures 
that are to be given a trial are recumbency 
of posture, diet, drugs, etc. Free saline 
catharsis and high colonic flushings may 
clear up some of the S3rmptoms. If, how- 
ever, the vomiting continues persistently 
and to the doctor's positive knowledge; if 
the woman is growing weak and emaciated 
with a weak and thready pulse; if nutrient 
enemata prove futile and the natural trend 
of the case is progressively downward, then 
the question of emptying the uterus must 
be considered. All sides of the case should 
be studied without bias or prejudice ; there 
is danger if he does and danger if he does 
not. The counsel of at least two other phy- 
sicians should be secured. The case must 
be studied from the objective rather than 
the subjective symptoms. While this is a 
case for "masterly inactivity," yet it is one 
that can not be postponed too long if in- 
terference is really indicated, lest the wo- 
man lapse into a low state of vitality from 
which she can not rally. Any case of vom- 
iting which is accompanied by symptoms 
of sepsis should have active palliative treat- 
ment. If there is not an amelioration in a 
few days, measures looking toward treat- 
ment more radical should be decided upon. 



To abort hay fever take a three-grain 
pill of zinc valerianate three times daily 
before meals for a full month before and 
after time of expected attack. 



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IN RESPONSE TO INQUIRIES. 



SOME PRACTICAL NOTES AND REPLIES. 



Editor Medical Summary: 

In response to your inquiry and several 
others of the same nature, I will say that I 
have usually used ignatia in about the pro- 
portion of eight to fifteen drops to a four- 
ounce prescription, dispensed in water, al- 
ways using specific or normal tincture of 
ignatia, which contains one grain of assay- 
ed drug to each minim of finished product. 
For the tonic mentioned I usually dispense 
fifteen drops of ignatia, forty drops of 
cinchona and thirty drops of dilute phos- 
phoric acid to four oimces of water. Give 
a teaspoonful every two hours, or three or 
four times a day, according to the case and 
the patient. For very nervous, delicate, or 
susceptible patients, eight or ten drops of 
ignitia to a four-ounce prescription is 
plenty. 

I have often used with great improve- 
ment, ignatia, cimicifuga, and cinchona for 
women who have just been through a hard 
and exhausting confinement. The quanti- 
ties here would be about ten drops ignatia, 
thirty drops cimicifuga and thirty drops 
cinchona to four ounces of water. Take a 
spoonful every two hours. For atonic dys- 
pepsia use ten drops ignatia, ten drops spe- 
cific bryonia and thirty drops cinchona to 
four ounces water. Take a teaspoonful 
every two hours. For patients recovering 
from acute alcoholism use twenty-five gtt. 
ignatia, sixty drops cinchona and sixty 
drops specific hyoscyamus to four ounces of 
water. Give every hour at first. 

Wm. M. Gregory, M.D. 
Berea, Ohio. 



Editor Medical Summary: 

I see ye Editor suggests in the May 
number the injection of alcohol for neu- 
ralgia. I have made some observations 
along that line and they do not agree with 
the Editor's views. I have a friend who 
has been injecting a quart a day of a fifty 
per cent, solution and still has neuralgia, so 
I have decided to cut it out, and seldom 
prescribe it for any purpose. Would that 
the medical profession could all take heed 
and do likewise. 

He also suggests taking vacation either 
in May or June, or both, calls them 
"balmy, invigorating months," and yet the 
first time I was overcome with heat was in 
the past May; says they are the healthiest 
months, in most sections of the United 
States — ^perhaps so, as I do not remember 
having seen one of them sick. He says 
acute diseases abate and the semi-invalids 
seem to take a new lease of life. Is not 
the reason obvious ? Are they not the doc- 
tor's usual vacation months? The liver 
and bowels get a much-needed rest from 
purgatives. The appendix goes free for the 
time being, and never becomes inflammed 
from calomel and podophylen. Hence no 
surgeon is needed. 

The digitalis heart and the strychniated 
nerves get a rest from the constant spur- 
ring and driving, hence no heart failures 
nor nervous wrecks. The hysterical fe- 
male quits the "dope," such as morphine, 
bromides, "fedita," and valerian, and has 
no more trouble, as the doctor is gone. 
The doctor has a good time, as he don't 
have to stay at home, but gets out, hunts 



^^5 



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THE MEDICAL SUMMARY 



and fishes, and so forth (more so forth 
than anything else), and spends a good 
portion of what his family earned while 
he was lying around home, then returns in 
time to eat fruit and "melons" in the hot- 
test season, when medicine will keep peo- 
ple sick longer than in the cooler months. 
They say "away back" in the country 
where they cannot get doctors, people sel- 
dom die, just dry up, or, if they conclude 
to die while they have a little blood left, 
and, like Carnegie, wish to die poor, they 
go out into the open and spend a while 
with some relative or friend who "uses" a 
doctor and manage to have a little flesh left 
on their bones, but nothing in their pockets. 

The Editor asks, "Will any of our read- 
ers heed a bit of paternalistic advice or 
council?" Yes, Pa, I will, so far as go- 
ing fishing is concerned, but as to the post- 
ing of books and sending out of statements, 
I have tried that and they do not have a 
particle more effect than the notices which 
The Summary and other medical journals 
send out to us doctors. So I swore off, 
and now I go after them. I am prancing 
along between the fiftieth and sixtieth mile- 
posts, but I feel like a fifteen-year-old kid, 
always ready to go fishing, as I expect, 
with all healthy people who take even 
moderate care of themselves, to live a 
hundred years. 

I have not been as good as I should have 
been, yet I have always obeyed my pa- 
rents when they said, go a-fishing. 

He says, clean up your instruments and 
read books, as the time has come that the 
doctor must be a man among men, be in- 
formed on general topics. I cleaned up 
what few instruments I had, but there are 
so many "contract" doctors, I have never 
had to use many of them, since I did read 
and read, but when I told a man the Re- 
publican party was more responsible for 
the '93 panic than for the 1907 panic, that 
a pound of cotton then would buy a pound 
of meat, but now it requires one and a-half 
to two to get meat, he didn't know whether 
the Democrats or Republicans were in 
power in '93, but didn't care anything 
about politics, as there was no more 
North nor South, all one, and he was right. 
I had been wasting my sentences on the 
desert air. 



We are all one — except one says you 
make the money and I will spend it for you, 
so I have decided to be a "knocker;" you 
see, you do not have to have any sense at 
all to be a first-class knocker, and if I 
can't be first-class I won't be at all; so the 
trouble is going to continue until we so- 
cialists revolute and change things up. It 
must be done, there must be a more equal 
distribution of wealth, and when it is di- 
vided and I get my part, I am going to rest 
forever, no more work for me. The rich 
could prevent this if they would, but they 
won't. How? By breaking up trusts and 
giving every man an equal chance and re- 
ducing the cost of living. We must live 
somehow, and we will. Meat that cost 
four cents per pound in '93, costs fifteen to 
twenty cents now, and we still charge $1.00 
a visit, as then. So much for reading and 
more for eating. 

As to the electrical outfit, I set that 
aside, as I want to grow honest before I 
die. It is not quite like Sam Jones' whis- 
key. He said it was good in its place, but 
hell was its place. That was so nearly 
correct that I won't dispute it. Electric- 
ity is good in the arts and in criminal exe- 
cution, but we must execute only criminals. 
I have read all about that doctor who 
complained that it was no good, and when 
interrogated as to his mode of use by a 
know-all, was told that he had been using 
it exactly wrong. That is not worth a 
fizz. Let your patient keep what he spends 
for electrical treatment and treat his dis- 
ease. Although the galvanic sometimes 
comes in well. He says you have more 
time in those months. Well, time is no 
object with me. I have plenty, thank you. 
Really sometimes I think that I have too 
much leisure, when I consider the bills 
that are coming in. 

There are several articles in the May 
number that I should like to notice, but the 
Editor cannot give me the space, but I have 
read all of them. For instance, I see Dr. 
Field is in the same old ruts with some of 
the rest of us old "fogies." What could 
be nicer in print than to see Dr. Field, who 
attended the injured parties, say they are 
all doing well, or Dr. Jones, who attends 
Judge Moore, who was thrown from his 
auto, yesterday, state that the Judge is 



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THE MEDICAL SUMMARY 



187 



doing nicely. Come, let's be up-to-date, 
Dr. Field, In another place he shows that 
The Summary is the best journal publish- 
ed, because it has practical contributors. 
Of course, doctor, we write for it, some- 
times, and there are others ; you are getting 
on the right line now, but no journal like 
The Summary. Dr. Davis, in his peculiar 
skin disease, wants to know what it is. I 
have had two similar cases, which, for 
want of a better name, I called peripheral 
neuritis. The pimples seem to be the result 
of rubbing or scratching, as if let alone 
they do not appear. I relieved mine by 
adding bismuth subnitrate to carbolized 
oxide of zinc ointment, which was applied 
instead of scratching, and Fowler's solution 
and saline laxative internally, but from 
what the doctor says, tieing the patient's 
hands behind him would be the surest and 
cheapest cure. I also use hot salt baths 
and gentle massage. 

Dr. Cooper's comment on Dr. Reed's 
treatment of typhoid fever is quite inter- 
esting. His not having lost a patient in 
thirty years is fine for patients, but so bad 
on him. Poctor, unless you have a burial 
sometimes, people will never know you 
have a large practice, as you never get 
them together at funerals to talk over the 
matter, as to treatment. I can almost agree 
with Dr. Harry, a neighbor of mine, who 
has had quite an experience in the treat- 
ment of typhoid. After listening impa- 
tiently to a lot of young M.D.'s discussing 
at an association the latest remedies and 
scientific treatment of the disease, was 
asked to give his views on the subject. He 
said: "Throw those damned things away 
and give mt a quart of turpentine and I 
will cure every case." The main point is 
to control the fever and keep your patient's 
skin moist, the bowels clear, with oil, rest, 
and feed him. When stimulants are needed 
I find liquid peptonoids with creosote 
comes in well; also buttermilk. 

H. X. Richardson, M.D. 

Gulfport, Miss. 



An exchange states that butter applied 
promptly to a bruise on the face will pre- 
vent discoloration. We doubt it. Still, this 
remedy would certainly rank among the 
safe if not sane forms of therapy. 



RANDOM NOTES FOR PRACTICE- 
COMMENTS, ETC. 

Editor Medical Summary: 

Not long ago a patient came to me from 
a farm about six miles south of Louisville. 
He was very much jaundiced. Skin and 
whites of eyes as yellow as a pumpkin. 
Chilly sensations, some fever occasionally, 
could not eat, could not sleep, sweat at 
night ; night-clothes and sheets yellow from 
the sweat. Was languid and could not 
work. Had been under treatment four or 
five weeks with no improvement. I gave 
him four grains of calomel in divided doses, 
followed by one and one-half tablespoon- 
fuls of castor oil. Then I gave him War- 
burg's tincture, in tablet form, five grains 
four times a day; also gave him one- 
thirtieth of a grain sulphate of strychnine 
three times a day. Used my treatment of 
electricity and massage three times a week. 
In four weeks he was well. Since I began 
treating him his brothers and sisters came 
to me in very much the same condition he 
was, and I placed them under the same 
treatment. They are all well. Ordered 
the cellar under the house drained, which 
they could readily do, and ordered the cel- 
lar walls whitewashed with crude carbolic 
acid in the whitewash. I think I have the 
trouble under control, or, I might say, I 
have gotten rid of the malarial influenza, 
and expect no more cases of malaria in 
the family. There are several other mem- 
bers of the family who have not as yet been 
affected. I do not believe they will be. I 
will report later what the result has been. 

I find it very difficult to always find the 
cause of indigestion and inactive liver. A 
patient applied to me a few, days ago who 
had indigestion, belching, nausea, etc. I 
questioned him in regard to his diet. He 
said they had put up forty gallons of cu- 
cumber pickles, and I forget how many 
gallons of chili sauce. He had put up some 
ten gallons of apple butter, and they had 
either pie or cake for every meal, with pre- 
serves, salads, etc. 

Of course I stopped him from all these. 
I find that so many of our stomach 
troubles have been produced from eating 
indigestible articles, and sedentary life, 
that about the first thing I inquire is, 



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THE MEDICAL SUMMARY 



"What do you eat? How much exercise 
do you take ?" * I invariably find my patient 
has been eating new biscuits, new bread, 
many sweets, etc. When I prescribe 'stale 
bread and a five-mile walk a day, they fre- 
quently go to some other physician. 

I have reached the point where this does 
not worry me in the least. I believe I have 
advised for the best), and my conscience is 
absolutely clear. I have no waking hours 
in the night with the idea prevailing that I 
might have done better. Young physicians 
have this condition. I had it when I was 
young myself, but have bravely gotten over 
it. When I prescribe now I do it with the 
idea that I am doing the very best for my 
patient that can be done. Now I do not 
mean to convey that I have reached per- 
fection, far from it, but I have reached the 
stage that certain medicines produce cer- 
tain results, and when I prescribe I am sen- 
sible of the result produced. 

This, I admit, sometimes varies, but as a 
rule it is correct, and I am governed ac- 
cordingly. Can we always rely upon the 
medicines we prescribe? I believe we can 
if the medicines are pure and what they 
ought to be. I am sorry to say we cannot 
always rely upon the medicines we pre- 
scribe, for they are not up to the pharma- 
ceutical conditions they ought to be. Gen- 
erally if we append to our prescription the 
names of the manufacturers of the medi- 
cines we find them to be genuine. I do not 
believe any of our prominent manufactur- 
ers are dirilect in using pure ingredients in 
their manufactory. If we do not do this 
we very frequently obtain inferior articles. 
Many druggists, I am very sorry to say, 
substitute some inferior preparation, or 
tion and many other diseases 
something of their own make for what we 
prescribe. In this event we do not ob- 
tain results. 

Christian Science I believe to be a hum- 
bug. I do not maintain, by any means, 
that influence or suggestion has no good ef- 
fects with our patient. I believe, yes, I 
know, it has. I would much rather treat 
anybody who has confidence in me than one 
who has not. But when I say this, my in- 
fluence will, as a rule, have no effect with a 
sluggish liver, an inactive kidney, indiges- 
That we can have a certain influence 



over our patients cannot be disputed, for 
every successful physician has. But that 
we can cure an organic trouble by this in- 
fluence I do not believe; we may, and un- 
questionably do have better results if our 
patients believe in us; yet we know that 
children do not believe in us, therefore we 
must have, at least in their cases, some- 
thing more than simple confidence. We 
also have to have in the treatment of adults 
something besides simple belief in us to be 
successful in the practice of medicine. I 
must state that I absolutely believe in the 
effect of medicine, and that we must give 
it in the treatment of diseases. The best 
medicine given in diseases depends to a 
great extent upon judgment and experience. 
Judgment first, and many, yes a great many, 
failures in the practice of medicine result 
from poor judgment. How often we find 
that some ignorant person medicinally has 
better results than the best learned in med- 
icine. This may , be explained by the ig- 
norant medicinal man having good sense. 
If we have not good sense and good judg- 
ment we will never make successful physi- 
cians, however learned we may be. Let us 
study the general and every-day conditions 
we find with those we meet every day. 

Then let us compare those conditions 
with the sick whom we are called to see. 
This will show us the difference between 
the well and the sick. When once we have 
learned this we have learned a great deal. 
Knowing the condition of the human fam- 
ily in health we will soon learn to know 
the diseases they manifest themselves. 
I do not believe the physician is sufficiently 
observant of those in good health to be 
enabled to compare health with disease. 
Search our inheritance in those who come 
into our hands for treatment. 

This often helps a great deal in our prac- 
tice. As a rule we have much more to con- 
tend with in those of poor inheritance phys- 
ically than in those of good inheritance. I 
bank a great deal on those who spring from 
good healthy parents than those who spring 
from a feeble and diseased race of the 
human family. It may be said that this is 
a minor condition to look at in our prac- 
tice, but it is not ; it is one of the most im- 
portant things to be studied and under- 
stood. 



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THE MEDICAL SUMMARY 



189 



Medicine is effectual, but it is most ef- 
fectual in those of good constitution and 
inheritance. We find instances where pa- 
tients come to us with poor constitution, 
poor or irregular appetite, skin yellow, 
kidneys inactive, yet able to be around and 
able to attend, in a manner, to business, 
but find it a burden to attend to business. 
What is the matter? Well, if we investi- 
gate their homes and surroundings we are 
apt to find a damp, mouldy cellar, with 
some water in it, and paper upon the walls 
of the house mouldy and loosening from 
dampness of the walls. We find in the 
vicinity some old pond that is being filled 
or that has been filled by the dumping of 
the city filth. 

What can we do? We can give relief 
by using calomel and castor oil with free 
doses of sulphate of quinine. In a short 
time we have to repeat our remedies. The 
only thing of a sensible nature to do is to 
obtain drainage by connecting with the 
sewers. 

Drainage by good sewers to a great ex- 
tent adds to good health. No one, how- 
ever strong his constitution or inheritance 
may be, can be well if the drainage is poor. 
See to it then when you buy or rent in the 
city that the sewerage or drainage is good. 
Never go into a house where the paper on 
the walls is mouldy or loose from moisture. 
Too many or our houses in every city have 
this dampness of cellar or walls, and no 
one can be healthy very long living in 
rooms where this prevails. 

Food. — In regard to food, it is difficult to 
absolutely state what one must eat. We 
find many different conditions of the stom- 
ach and so many different stomachs that 
we cannot say, thus sayeth the Lord in re- 
gard to eating. We have to watch the con- 
ditions of digestion of certain foods and 
recommend or debar their use. As I said 
before, we can have no cast-iron rules in 
regard to diet. City life, I suppose one- 
half of the human race live in cities. We 
find many cities perfectly healthy, but we 
find many more, I think, absolutely un- 
healthy. 

In the country, as a rule, there can be 
nothing absolutely interfering with sanitary 
conditions. I remember that my early 
practice in Illinois, in a Norwegian com- 



munity, I had a great deal of unsanitary 
conditions to contend with, even in the 
country. But when I taught my clientage 
the laws of health they avoided a great 
many unhealthy conditions. I found it very 
difficult to impress upon them the different 
conditions existing between the cold cli- 
mate of Norway and the temperate climate 
of Illinois. I had in my early practice 
many dirt diseases to contend with. Be* 
fore I left Illinois these filth diseases had 
almost subsided. The Norwegjans are a 
keen and quick understanding people, and I 
could not desire their good health more 
than they themselves did. They placed 
great confidence in me, and whatever I 
recommended they were more than willing 
to adopt. The dirt or filth diseases soon 
decreased in my Illinois practice. It was a 
pleasure to know that so many Norwe- 
gians were anxious for me to remain in 
Illinois in the practice of medicine, a 
large petition was sent me requesting me to 
remain. 

Surgery. — Surgery, without doubt or 
question, is a great boon to the human 
family. This is the case if the surgeon is 
conscientious in his practice and opera- 
tions. I am well aware, however, that all 
those making a pretence of being surgeons 
are not honest in their practice, or other- 
wise are very ignorant. Many of the 
surgical operations performed to-day are 
absolutely unnecessary, yes, are really 
harmful. Old surgeons do not perform 
those operations, but the young surgeon 
altogether too often operates to the detri- 
ment of his patient. Now this is all wrong. 
How often it is that the relatives to the 
patient, and even the patient himself, will 
not have an operation performed and yet 
recovers in health. We should study our 
case well before using a knife upon the 
patient. Yoimg surgeons who perform 
these unhealthy and harmful operations 
may g^in technique and experience in op- 
erations, but they do not, as a rule, gain 
business, the people, as a rule, are not idi- 
ots. They often know that operations per- 
formed by surgeons are unnecessary and 
hazardous, and if the patient dies he will 
hear them claim, I told you so, and all that 
that surgeon wanted was a big fee for op- 
erating. I am sorry to say that very 



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THE MEDICAL SUMMARY 



often this verdict rendered' by the laity is 
true. Let us be more true in our practice 
of surgery, also in medicine, and it, in the 
long run, will be to our benefit and success. 
Geo. J. Monroe, M.D. 
Room 6i8 The Paul Jones, 
Louisville, Ky. 



"THE VALLEY AND THE SHADOW." 



Editor Medical Summary: 

We do not know how long one may live, 
nor how soon one may die ! We ought to 
be very guarded in prognosis. I was 
present with a company at dinner a few 
days ago, when a young physician announc- 
ed that a comatose soplonarian, who was 
afflicted with Raumollisement, would not 
live twenty- four hours. I warned him that 
he should not make such positive prognosis, 
as such persons would surprise you in the 
length of time they might live. The man 
is still alive; but to be sure he is in that 
stupor from stasis of the cerebral blood 
vessels. He has already lived several days 
longer than the attendant predicted. It's a 
common resort of premature prognosis to 
attribute the prolonged coma to a, wonderful 
constitution! The fact is, the constitu- 
tion hasn't anything to do with it; but it is 
due to the nature of the disease. It is also 
true, that some persons have more vitality 
than others; but now that is hard to esti- 
mate. I had an old patient who had passed 
his 92nd year, and when he got bedfast, I 
expected every morning, for a week or 
more, to get a telephone message that he 
was dead; but morning after morning, I 
was disappointed. I had another 80-years- 
old patient, who had cancer all over the 
face, who neither ate nor drank for three 
weeks before death. Another, as old, 
who had malignant disease of the prostate, 
which broke into the rectum, and he lived 
three weeks in a semi-comatose state. So 
I have not made any predictions as to how 
long a lingering case will last, even if 
there is stupor or coma. Just tell the 
friends, that the patient will live till the 
disease is fatal. 

D. L. Field, M.D. 

Jeffersonville, Ind. 



POISON IVY. 

Editor Medical Summary: 

The little note on 'Toison Ivy" in your 
journal recites a number of old-fashioned 
alleged remedies, all of which, I believe, 
have only a slight effect. Having been a 
great sufferer from poison ivy and tried all 
of the remedies usually prescribed by good 
physicians, I have found that wood alcohol, 
applied as a lotion, is so immediately effec- 
tive that I am no longer afraid of the 
curse. Wood alcohol, full strength, has no 
bad effect on my skin. It might need to 
be diluted with water for some skins. Ap- 
plied early, at the appearance of the irri- 
tation, it stops further spreading and prac- 
tically eliminates all discomfort. 

I wish some of your readers would try 
this further and report results. 

Charles Wirt. 

Germantown, Philadelphia, Pa. 



ADVANCES IN CREOSOTE MEDICATION. 

Editor Medical Summary: 

Noticing your extract from an article 
written by Dr. Beverly Robinson under the 
head of Creasote Treatment of Pulmonary 
Tuberculosis, with your editorial comment 
or request, in the May Summary, I wish to 
add my mite of information, a mite that is 
based wholly on genuine experience of my 
own. 

It is that I deem that one great advance 
along this line of creosote medication is the 
new substance known as calcium creosote, 
which seems to be a true chemical combina- 
tion of calcium creosote by means of 
which as much as 96 grains of pure beech- 
wood creosote may be taken without dis- 
comfort in the twenty- four hours. 

Since the difficulty heretofore has been 
to saturate the system sufficiently to get the 
full action of the medicament, I consider 
this a real chemical advance and triumph, 
heralding and recording in the archives of 
midicine as marking an epoch. My use of 
it in tuberculosis proves it conclusively to 
me, and in a remarkable manner. 

Yours for the cause and the cure, 

A. P. Reed, M.D. 

Naples, Maine. 



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Spondylotherapy Physiotherapy of the 
Spine Based on a Study of Clinical 
Physiology. By Albert Abrams, A.M., 
M.D. (University of Heidelberg), F.R. 
M.S. Consulting Physician to the Mount 
Zion and French Hospitals, San Fran- 
cisco; formerly Professor of Pathology 
and Director of the Medical Clinic, 
Cooper Medical College (Department of 
Medicine, Leland Stanford Junior Uni- 
^er^ity), San Francisco. Third Edition, 
enlarged. The pathology of spondylology 
is founded on chnical physiology, and its 
methods embrace the therapeutics of the 
reflexes. Philopolis Press, Publishers, 
Suite 406 Lincoln Bldg., San Francisco, 
Cal., 19 1 2. Price, cloth, $5.00 net. 
Here is a book it will be your worth 
while to take notice of; the matter it con- 
tains is important to every practicing phy- 
sician; general practitioners especially 
should investigate what Dr. Abrams has to 
say on the subject. In the first place, what 
is Spondylotherapy? It is a system of treat- 
ment founded on clinical physiology, and in 
its methods embracing the therapeutics of 
the reflexes, some of the results, says an 
eminent French clinican, are positively mi- 
raculous (preface). 

In fact, it is Osteopathy placed on a sci- 
nancial interest. 

entific basis, eliminating that which is false 
and adding other important scientific facts, 
and serving it all up in such a form that it 
becomes an important adjunct to be utilized 
by the physician to the advantages of his 
clientele and adding largely to his own fi- 
A third edition of this remarkable work 
being called for so soon after the first hav- 
ing made its appearance is certainly an in- 
dication of the interest visibly manifested 
on the subject by the profession, but there is 
no wonder about this, as it is a book on a 
live subject, and one that should be thor- 
oughly understood by every general practi- 
tioner. It is based upon actual clinical ex- 
perience. The author's presentation of 



facts and arguments arc unanswerable, be- 
cause they are logical and scientific. 

Laboratory Methods^ With Special Ref- 
erence TO the Needs of the General 
Practitioner. By B. G. R. Williams, 
M.D., assisted by E. G. C. Williams, M. 
D., formerly Pathologist to Northern 
Michigan Hospital for the Insane, with 
an Introduction by Victor C. Vaughan, 
M.D., LL.D. Illustrated with forty-three 
engravings. C. V. Mosby Company, 
Publishers, Metropolitan Building, St. 
Louis, Mo. 19 1 2, Price, cloth, $2.00. 
The fact that Dr. Victor C. Vaughan, of 
Ann Arbor, Mich., in his introductory re- 
marks has given his approval of this book 
in unmistakable terms should prove a suf- 
ficient guarantee of its practicallity. The 
authors of this book have striven to give 
the student and the country practitioner 
those methods the application of which will 
get results in laboratory work, and endeav- 
ored to prove that the general practitioner 
can, at very small cost, equip a laboratory 
in which he can do most excellent work. 
It demonstrates that costly apparatus and 
marble rooms are not strictly necessary for 
the prosecution of scientific medicine. 
Vaughan gives some examples of what 
country physicians have contributed, and 
says that, if we take away from medicine 
the contribution to that science made by 
physicians far removed from great com- 
mercial centers, we rob it of half of its 
glory and its honor. 

It has been the aim of the authors of 
this admirable book to simplify methods 
both as to apparatus and technic, and we 
can testify that they have succeeded most 
admirably in their every effort. Every 
general practitioner should procure a copy 
of this book, and study it carefully, and it 
will show that many of the comparatively 
simple cases that are usually sent to dis- 
tant cities for expert examination may be 
made with more satisfactory results by the 
practitioner at home. 



191 



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Glycerite of Hydrastis is excellent in 
stomatitis and follocular pharyngitis. 

Hydrogen peroxide is a good haemo- 
static in epistraxis. 

Ten drops of flld. ext. hyrhastis in water 
every two or three hours is excellent in 
epistaxis. 

The symptoms of acute tonsilitis are 
usually more sudden in onset and the tem- 
perature higher than in diphtheria. 

The fact remains, however, that facts 
are tacts, and definite results are proofs 
which cannot be ignored. 

A unilateral discharge from the nose of 
a child should make the physician suspi- 
cious of a foreign body. 

Ozoena may be due to atrophic rhinitis, 
tertiary syphilis, empyema of any of the 
sinues, or a foreign body. 

After removing a foreign body from the 
eye a drop of castor oil will give immedi- 
ate relief. — Amcr. Jour, of Surgery. 

In all chronic ear diseases the history of 
the case will give the physician fuller 
knowledge of the condition than will an 
examination alone. 

In acute tonsilitis give a calomel purge, 
gargle with hydrogen peroxide and give 
pheiiacetine and salol ii^ternally. Later 
remove or cauterize tonsils. 

When adenoids are found with slightly 
enlarged tonsils removal of the adenoids 
alone will frequently be followed by a re- 
duction in the size of the tonsils. 

Insufficiency of thyroid .^ecretion is be- 
lieved by some writers to cause urinary in- 
continence. Williams has used de iccate 
thyroids, one-half grain twice a day, in 
children between the ages of 2 and 6, with 
good results and Ruhrah is also satisfied 
with his experience after using this treat- 
ment. 



In acute throat disorders, freshly-pow- 
dered cubeb taken frequently and in mod- 
erate amount, dry on the tongue, has been 
of more service to the author than any 
other drug. 

Creosote inhalations and moderate blood- 
letting, especially wit^ leeches, are ex- 
tremely useful in croupous pneumonia. 
The application of a few leeches, locally, 
cannot be replaced by any other agent in 
many acute, painful inflammatory affec- 
tions. 

Rhubarb and soda, or rhubarb and mag- 
nesia, either in mistura rhei et sodse or in 
Gregory's powder, are most useful in gas- 
tric disorders with fermentation or hyper- 
acidity. 

Warm, moist applications after the ap- 
plication of leeches, or, frequently, when no 
leeches have been applied, are more sooth- 
ing and more useful locally in appendicitis, 
pneumonia, pleuritis and endocarditis than 
the now fashionable ice-bag. 

Keep your hand on the uterus for an 
hour after delivery and you will havo no 
hemorrhage. 

The examination of the patient should 
be frequent enough to ascertain the posi- 
tion of the child and the progress of the 
case. 

Where the *'bag of waters" do not mate- 
rially assist dilatation, the intelligent, slow 
and gradual dilatation, by means of the 
fingers is productive of much good. 

It is well to administer chloroform, spar- 
ingly, while the head is passing the infer- 
ior strait. 

In hay fever you will usually find an ob- 
structive lesion in the nose, a neurotic tem- 
perament, and an irritating substance in 
the air which acts as an exciting cause. 

Glaucoma differs from cataract by pain, 
dilitation of pupil, narrowing of thfc field of 
vision, cupping of optic disc, and absence 
of opacity of the media, except during in- 
f.ammatrrv exacerbations. 



192 



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A Montbfar Journal ci 

Practical Medicine, New Preparations, Etc 

R. H. ANDREWS, M.D., Editor mkI PublUher. 2321 Park Are., FhUa.. Piu 
One Dollar Par Aonum in Adrance. Single Copies, 10 Cents 



Vol XXXIV. 



Phikddphia. September. 1912. 



No. 7 



SUBSOBIPTION RATES: $1.00 per year, in ad- 
▼ance, to anr part of tbe United States and 
Mexico. To Foreign Oonntries and Canada, $1.26. 

HEW SXTBSCBIPTIONS may begin at any time dur- 
ing the year. 

HOW TO BEIOT: A safe way to remit is by postal 
money order, express order, check, draft, or regis- 
tered mail. Currency sent by ordinary msil nsn- 
ally reaches its destination safely, but money so 
sent must be at the risk of the sender. 

BE0EIPT8: The receipt of all money is immedi- 
ately acknowledged by a postal card. 

OELAJSOBB OF ADDBESS: Subscribers changing their 
addreases should immediately notify us of their 
present and past locations. We cannot hold oar- 
seWes responsible fur non-receipt of the Journal 
in such cases, unless we are thus notified. 

DISCONTZNTTAKCBS: The Summary is continued to 
responaible subscribers until the publisher is noti- 
fied by mail to discontinue, when payment of all 
arrearages mnst be made. If yon do not wish 
The Summary continued for another year after 
the time paid for has expired, please notify us to 
that effect. Address 



•THE MEDICAL SUMMABT,* 



2321 Park At*., 



Philadelphia. Pa. 



Entered at Phila. Post Offiee as second-class matter. 



BUSINESS TIPS. 

There may be nothing original in what 
we now say, but you will take it for what 
you think it worth. We believe it is well 
to get the habit and endeavor to keep the 
bills collected up as closely as possible. A 
bill is more difficult to collect as it grows 
in age. Here are the reasons: The 
debtor gradually becomes indifferent con- 
cerning it, while perhaps the bill continues 
to grow a little from month to month. 
After a while the bill is so large that he 



thinks the doctor is trying to rob him in 
v^ver-charges, and if he is financially irre- 
sponsible he will change doctors rather 
ti-an attempt to pay it. 

In order to make clear such conditions 
as this we believe the physician should 
make his book-keeping so plain that an 
itemized statement can easily be made if 
the debtor should question the correctness 
of the account. It is a good plan to send 
out statements frequently in order that 
patrons may know exactly how they stand. 
Judgment is necessary in fixing the fee 
as well as in collecting it. There has 
never been formulated any scale of fees 
that can be adhered to by physicians quite 
generally. So much depends upon envi- 
ronments and circumstances and people's 
ability to pay. These have ever been and 
will ever be the rock on which fees must 
split. Equality of fees is nice in theory, 
but in practice it doesn't work. The mat- 
ter of adjusting the right fee in each case 
and in such a manner as not to react un- 
pleasantly upon the physician is one of 
nicety and precision. As a general rule 
the fee should be sufficiently large to both 
the indigent and the prosperous; in the 
case of the former the unpaid difference is 
checked off by your hospitality, in other 
words, a well-to-do individual is not held 
up simply to offset the debt of a poor-pay 
patient. • Sometimes people on the seamv 
side of life suddenly prosper or inherit 
money. If the doctor has a live accvmnt 
on such persons they are, as a rule, glad 
to settle the old score. 



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194 THE MEDICAL SUMMARY 

HOW MUCH TO TELL THE PATIENT. CONJUNCTIVITIS. 



We are constantly changing front in 
many matters medical. It was the rule a 
decade or so ago for the physician to tell 
the patient and friends very little concern- 
ing the character of the case at hand or its 
probable outcome. We have seen physi- 
cians with a curtness almost equal to inso- 
lence dismiss any inquiries regarding the 
case of a sick relative or friend. The phy- 
sician who refuses to honestly answer anx- 
ious inquiries is possessed of a cheap dig- 
nity or assihity that should warrant his dis- 
missal. The truth cannot be concealed for 
'ong, so on the whole it is more satisfactory 
if a mutual heart-to-heart understanding 
between doctor and patron be early entered 
into. If the truth is severe, let it be toned 
down and the sharp corners blunted off. 
If the patient has a simple working knowl- 
edge of his own case he is better prepared 
to enter into co-operation with his physi- 
cian. It may be somewhat annoying to be 
obliged to answer foolish questions put to 
you by the patient, but after all he will 
profit by your information, provided it be 
presented to him in a way that he can as- 
similate it. For example, who would think 
nowadays to withhold from an individual 
the fact that he is harboring the tubercle 
bacilli about his person ? In such cases ig- 
norance only increases the danger to the pa- 
tient, as well as menacing the lives of 
others. Yet physicians too often resort to 
all sorts of subterfuges to keep patients ig- 
norant of the true state of affairs, thereby 
lessening their chances of recovery. How 
many cases of tuberculosis have passed as 
"catarrh," "bronchitis," "female disease," 
"indigestion," etc. If the patient were told 
early in such cases and his hearty co-opera- 
tion enlisted, many a cure might result. 
The same is true of many other diseases. 
So, we argue that in most cases it is better 
for both physician and patient if the latter 
be given a reasonable insight into the char- 
acter of his ailment that he may be better 
prepared to fight it out. There are, of 
course, certain facts connected with almost 
every case that the physician must meet 
with tact and diplomacy. 



The general practitioner is called upon 
for advice in many cases of both acute and 
chronic conjunctivitis. It might be, more 
fitting for these cases to apply to the occu- 
list, but that individual is not always avail- 
able. Furthermore, the general practi- 
tioner's fees are usually lighter, and this 
fact appeals to poor people. And still 
again, we believe the average doctor can 
soon acquire the necessary technique and 
knowledge to treat the more common eye 
affections successfully. 

The first aim in acute inflammation 
should be to find out whether any foreign 
substance is in the eye, thus provoking the 
trouble. A few applications of cocaine are 
useful in painful conditions and help to 
allay inflammation and promote the cure. 
It is the persistent use of cocaine that does 
harm in dilating the pupils, ruffling up the 
epithelium, etc. Boric acid solution is al- 
ways a safe and sane remedy, and the eye 
should be thoroughly lavaged with it as 
hot as can be borne. If the eye is red 
and injected pledgets of cotton should be 
soaked in a saturated solution of cold bor- 
acic acid solution and kept applied to the 
eye, being changed frequently. In nearly 
all eye inflammations, rest in a cool shaded 
room is a thing greatly to be desired. 

Inflammations dependent upon trachoma 
also demand non-use of the eyes and a 
great deal of physical and mental rest. 
The usual remedy in this condition is ni- 
trate of silver in the proper dilution as 
well as applicatipns of the mitigated stick. 
When silver applications are thus made it 
is well to neutralize the excess by a saline 
solution. A newer method of dissipating 
granulations is by rubbing them with a 
specially-prepared sand-paper, cocaine first 
having been used in a four per cent 
strength. 

As an astringent and mildly sedative in- 
stillation fluid in many eye inflammations 
one grain of sulphate of zinc and one 
grain of morphine to the ounce of dis^ 
tilled water is a favorite with many. A 
little camphor may be used with it if de- 
sired : also cocaine if the pain is such as to 
demand it. 

Boracic acid water and salt water are 



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THE MEDICAL SUMMARY 



195 



the nearest substitutes for normal tears and 
this fact accounts for the salutary effects 
of these agencies in inflammation. 

It should be impressed upon the patient 
that absolute rest is necessary in many 
types of eye inflammation. In order to 
secure it we may at times be compelled to 
paralyze the accommodation for a short 
time. 



REBIEDIES AND MEASURES FOR FACILI- 
TATING LABOR. 

Quinine has undoubted value in the first 
stage of labor in flicking lagging pains in- 
to greater activity and thus in a measure 
speeding up a tardy case. It must be given 
in large doses — ten grains upward — in or- 
der to get results. Its untoward effects are 
to leave the woman with a headache and 
her nerves jarred up, while in anemia and 
certain dyscrasias quinine favors postpar- 
tum hemorrhage, due to some chemical ac- 
tion upon the fibrin element of the blood. 
Whiskey or brandy may have a measure 
of value in some cases. Strychnine is use- 
ful when the uterus manifests an atonicity 
and the general vitality is low. In order 
for strychnine to give results it should be 
administered hypodermically and some time 
before the termination of labor. Hot drinks 
are of much value, as ginger, pepper, etc. 
Hot coffee is a great spur to a lagging 
labor. Observers have reported sugar to 
be a valuable stimulant of labor. The 
editor has never been able to confirm this 
in actual practice. 

Sedatives and relaxants often help along 
a slow labor better than stimulants. Among 
these are morphine, hyoscine, caulophyllin, 
emetine, apomorphine, chloral and chloro- 
form. Passiflora is a remedy employed by 
many obstetricians. Chloroform seldom 
retards labor, but usually facilitates it 
mitigating subjective suffering and **nerv- 
ing" the woman and thus ennabling her to 
help herself. In order to relax a rigid os 
chloral must be used in full doses, and if 
employed per enema it must be given in 
double the dose taken by the mouth. In 
convulsions chloral is given per rectum in 
30 or 40 grains. Veratrum should also be 
given boldly until the pulse comes down to 
60 o*- 70. 



The sitz bath employed for an hour is 
one of the best of conservative measures 
calculated to accelerate labor. It must be 
done thoroughly in order to be of avail. A 
rectal injection often starts matters out 
right. If there are no contraindications 
for so doing, the woman should be kept on 
her feet until the labor is well advanced. 
This tmites both cephalic and hypostatic 
pressure, thus securing the wedge-like dy- 
namic force that is here a sine qua nan. If 
the membranes have served their purpose 
and are no longer needed they may be con- 
servatively ruptured and the amniotic fluid 
drained off. An excessive quantity of fluid 
in the condition known as hydramnios may 
hold back a labor indefinitely, preventing 
the presenting part from becoming engag- 
ed. When the "bag of waters" is a hin- 
drance it should be promptly removed. 



MOUTH HYGIENE. 



If we were as painstaking in keeping 
our teeth as clean as our faces, much suf- 
fering would be prevented, and dentists 
would not be compelled to work overtime. 
Not only should the teeth be kept well 
cleansed, but the buccal cavities and re- 
mote recesses of the oral opening should 
have regular and persistent attention. Far 
too often these rather inaccessible corners 
of the mouth are in a far from septic con- 
dition because of debris which collects and 
disintegrates, thus menacing the integrity 
of the teeth. The wisdom teeth play out 
in a short time — not because they were in- 
tended to be short-lived, but because they 
are far back and in a somewhat septic 
area. The agents needed to keep a clean 
mouth and thus favor sound and service- 
able teeth are the tooth brush, dental 
iioss, wooden tooth-picks, water and a 
simple antiseptic wash. The following is 
a ocod mouth wash: 

Thymol 4 gr. 

Benzoic acid 45 gr. 

Tinct. eucalyptus 225 gr. 

Spts. peppermint 60 gr. 

Chloroform 15 gr. 

Alcohol 3 oz. 

Twenty props of this solution in a glass 
( f water may be used at a time. 



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196 



THE MEDICAL SUMMARY 



TREATMENT OF HEADACHE. 

No ailment is treated more empirically 
than headache. There are many types and 
many names for the condition which we 
naively term headache. Causes, legion. 
It occurs twice as ofteu in females. A few 
factors of causation are gastric irritation, 
constipation, autotoxemia, renal insuffi- 
ciency and various diatheses as well as the 
neuroses. 

The seat of pain is thought to be in the 
pia mater and the cerebral cortex. The 
immediate attack is a vasomotor disturbance 
with a consequent hyperemia of the brain. 
Search diligently for the cause. If the 
etiology is in a neurosis, and therefore 
somewhat akin to epilepsy, the treatment 
would be quite differtnt from a case due to 
anemia, nephritis, toxemia or aural or 
ocular irritation. 

The diet and habits of the sufferer should 
be looked into judiciously. Since one straw- 
berry will almost poison some people, it is 
plausible to think certain other articles may 
exert an untoward and far-reaching effect 
in individuals with just the right idiosyn- 
crasy. Coffee, for example, is wholesome 
for some folks, but with others it is posi- 
tively known to keep up a perennial head- 
ache. The sufferer from headache is usu- 
ally anemic or hyperemic, thin or plethoric. 
Temperament and habits of the individual 
must be taken into account in outlining 
treatment. 

Autotoxic conditions must be rigidly com- 
batted. As many cases of chronic headache 
are ameliorated by a course of water drink- 
ing, and others by a daily drenching with 
castor oil, there is emphasized the idea of 
looking for absorption into the blood from 
the intestinal canal. 

Many cases of headache are improved by 
increasing the amount of sleep and also in- 
creasing the intake of oxygen both during 
sleep and waking hours. The migrain vic- 
tim should have no less than eight hours of 
refreshing sleep, and many would fare bet- 
ter with nine or ten. 

The treatment of headache does not, of 
course, consist in taking drugs. Every se- 
dative, anodyne and hypnotic in materia 
medica has been given a thorough try-out. 



Some cases are relieved by a long course of 
cannabis indica. If there is ample evi- 
dence of a uric acid element, a dose or two 
of nitro-muriatic acid at the beginning of 
the attack may lessen its severity*. It is 
best taken in strong lemonade, and is the 
treatment once suggested by Dr. Haig. If 
there is a full stomach in the incipiency of 
the attack emesis should be produced with 
i-io grain of apomorphine administered hy- 
podermically. Of local medicaments em- 
ployed chloral, menthol, and chloroform in 
some form are top-liners. Coal-tar seda- 
tives are universally condemned, but nearly 
every physician employs some one of his 
choice and with no untoward results to his 
patient. 



OPHTHALMIA NEONATORUM. 

This distressing condition is always pre- 
ventable. As soon as the head is born the 
eyes should be cleansed with boracic acid 
solution. The hands should also be 
cleansed on account of the infant instinct 
to dig its fingers into its eyes. The in- 
stillation of a drop or two of nitrate of 
silver solution into each eye completes the 
prophylactic procedure. One per cent, so- 
lutions are commonly employed, although 
those competent to speak on this matter 
state that a one-tenth of one per cent, solu- 
tion is sufficient. Some assert that one- 
fifth per cent, is as strong as should be 
used for prevention and one-half per cent, 
for treatment. In the treatment of the 
disease the milder silver preparations may 
be used to advantage, protargol two per 
cent, and argyrol twenty per cent. 

When ophthalmia unfortunately occurs, 
persistency is the watchword in its treat- 
ment. This can be better accomplished in 
the hospital under a constant care of com- 
petent nurses. As important as specific 
remedies is that of thorough cleansing of 
the eyes by expressing the purulent matter 
and applying cold packs. The puss should 
not be allowed to accumulate in the con- 
junctival sac. The treatment demands the 
constant attention of a special nurse. 



Dullness of hearing, otitis media, tin- 
nitus are frequently due to adenoids. 



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I for the 



PELLAGRA. 



By M. G. Price, A.M., M.D. 




Very contradictory syhiptcms are often 
seen, as follows: 



Either — 
Loss of appetite • 
Somnolence 
Sensation of burning 
Reticence 
Diarrhea 
Hydroniania 
Immobility 
Mydriasis 
Salaciousness 
Stupor 
Marasmus 



Or--- 
Voracity 
Insomnia 
Sensation of cold 
Loquacity 
Constipation 
Repugnance of water 
Excessive mobility 
Mycosis 
Impotence 
Mental excitement 
Florid health 



Diarrhea. — Bowels move many times a 
day: thin, greenish, yellowish, offensive, 
bloody mucus; may be involuntary; some- 
times obstinate hemorrhage. Persists 
through spring and summer months with 
slight recrudescence in October. Disap- 
pears during winter. 

Gastric Symptoms, — Quite n^arked. An- 
orexia and burning in stomach common. 
Mouth congested, buccal mucosa red and 
covered with small ulcerated areas. 
Tongue fiery red (cardinal tongue). Pa- 



pillae prominent. Ptyalism fearful in 
some cases; tenacioub, ropy saliva, which 
hangs Irom upper to lower teeth. 

The Hands, — The dorsal aspects of the 
hands are of deep purplisii color, covered 
with dry, hard, cracked epidermis; des- 
quamates dry, bran-like scales. Line of 
demarcation at wrists where sleeves end is 
very distinct. Burning and itching. 

A crz'ous and General Symptoms. — Spir- 
its depressed, melancholia, dementia. Ver- 
tigo common. Mutism a pronounced syni- 
tom in many cases, and patient when 
spoken to may wait ten minutes before 
answering, sometimes not at all. Pulse 
80 to 100, sometimes 160 in bad cases. 
'I'emperature less than 100; in bad cases 
102 to 108. 

Treatment. — Withdraw all oils and fats 
except castor oil. Clean out with calomel 
and salines. Symptoms are worse when 
bowels are checked, better when cleansed 
out and moving. Calcium sulphide, Yi to 
2 grains, or more, three times daily. Stools 
are reduced to normal, redness of tongue 
fades and ulcerations heal. Hands clean 
off under its influence. 

Use no ointments. For insomnia open 
bowels and kidneys. Relieve insanity by 
same method. Give morning doses of 
one to two drams of castor oil. For pain 
in stomach or bowels, paregoric or mor- 
phine hypodermically. 

Diet. — Milk, cereals, vegetables, lean 
meat, shredded wheat, oatmeal, eggs, 
chicken and fresh buttermilk. Feed gen- 
erously. Iron, arsenic and strychnine as a 
tonic if needed. 

As a specific I would rely upon calcium 
sulphide. Its effects are wonderful and in 
the first year you will control the situation. 
The American epidemic is on, and as with 
some other diseases, it seems to attack a 
few people with special virulence. 



Mosheim, Tenn. 



197 



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198 



THE MEDICAL SUMMARY 



CUTANSOUS HORNS. 

By Earl E. Boyd, A. B., M.D. 

Cutaneous horns are hypertrophic masses 
of horny epithelium which assume horn- 
like shapes. 

Symptomatology. — In appearance they 
resemble small horns, and are Usually 
curved or twisted. They vary in size and 
are of a grayish or blackish color, situated 
upon a firm hard base. 

The surrounding skin is usually inflam- 
ed. Their usual locality is upon the face 
or scalp, but they may be found elsewhere. 

Etiology and Pathology. — They may oc- 
cur in the young, but are usually a trouble 
of the aged, along with other senile 
changes. 

The base consists of a hypertrophied 
papilla, which forms a round projecting 
mass over which the horn fits. 

Treatment. — Removal by either excision 
or by any good caustic. 

A Case. — ^Mrs. P., an American, aged 98 
years, had been annoyed for about eighteen 
months by a cutaneous horn, located on 
the left cheek, about an inch below the left 
eye and one-half inch to the left of the 
nose. It was an inch in diameter at base 
and over one-half inch from apex to base, 
shaped like a trunciated cone. Its early 
growth had been slow, and efforts were 
made to dissolve it by applications of va- 
rious caustics. Some six months ago a 
part dropped off. This seemed to stimu- 
late growth and from this time it increased 
in size very rapidly. 

The apex was hard and homy, of a 
dark grayish color, the base round, firm, 
and the skin covering it inflamed. It be- 
came very annoying because of its weight 
constantly dragging down upon the skin, 
keeping the eye open and inflamed. A 
facial neuralgia was an almost constant 
symptom. Under protest, because of pa- 
tient's age, I consented to remove it. 

My attention was called a few days be- 
fore this to quinine hydrochloride as a local 
anesthetic, it being claimed to be quite 
lasting in effect and to have no bad after 
effects. 

Not caring to take the chances with any 
of the older anesthetics, I determined to 
use this to me a new one. I followed in- 



structions literally as to administration, 
and after a reasonable time made an eiip- 
tical incision through the skin around the 
base of the mass and desected it out. I 
found it easily removed, but being nour- 
ished by a large artery, the hemorrhage 
was profuse. The artery was ligated and 
wound closed. Dry dressings were used 
and union secured by first intention. I 
might add that the neuralgia has been 
somewhat relieved. As to the anesthetic, I 
wish to say that in this case it did all I 
could ask it to do. The patient never 
complained of any pain during the opera- 
tion and there were no after effects 
whatever. 

Central City, Nebraska. 



ATROPINE OR STRYCHNINE. 

By George L. Servoss, M.D. 

In the July Summary the Editor asks: 
"Doctor, why do you administer atropine 
in preference to strychnine as a stimu- 
lant?" This is rather a broad question, 
when we take into consideration that, as a 
rule, atropine is an antispasmodic, rather 
than a stimulant and that, as a general 
rule, it is employed to allay spasm, rather 
than to act as a general stimulant. Of 
course atropine is stimulant, under certain 
conditions. It does stimulate peristalsis, 
and does increase kidney function, but it is 
due to inhibition of the centers governing 
t\'o functions of the bowel and kidney. It 
does increase the blood pressure, especially 
of the periphery, but this is due to inhibi- 
tion of the peripheral nerve ends, which 
have to do with the control of the blood 
vessels of this portion of the economy, 
causing practically a paralysis of the walls 
of the blood vessels, allowing a contraction 
thereof to take place. It stimulates the 
heart, through central action. It does not 
act upon the voluntary muscles, but large 
doses do paralyze the non-striattd. In 
fact, the action of the drug, especially upon 
highly organized tissue, is invariably de- 
pressant rather than stimulant. Even 
though it may stimulate peristalsis, it can- 
not be classed as a direct stimulant, in that 
this increased function is due to paralysis 
of the inhibitory fibers of the splanchnic, 



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and is secondary rather than primary ac- 
tivity. Large doses paralyze peristalsis. 
Although atropine may act to aid bladder 
function in retention, this follows the 
quelling of spasm rather than stimulation 
of the bladder. It increases the kidney 
function, but probably through inhibition, 
rather than stimulation. Atropine acts as 
antihydrotic through paralysis of the ter- 
minations of the secretory nerves. As a 
mydriatic, we find that dilation of the 
pupil follows paralysis of the peripheral 
ends of the oculomotor nerves, with stim- 
ulation of the peripheral ends of the sym- 
pathetic nerves. In fact, by following this 
diug throughout, it will be found that the 
main action is that of an antispasmodic, 
rather than a stimulant. It is employed, 
other than in the eye, to allay spasm, and 
even in the local application of this sort it 
is employed to relieve tension, due to 
ocular spasm. Practically the only use of 
the drug, other than an antispasmodic, is in 
the stimulation of the circulation, and to 
increase peristalsis, but in both instances 
it is seen that these actions are due largely 
to paralysis of inhibition, rather than stim- 
ulation, per se. Medicinal doses have no 
apparent effect upon the spinal cord, al- 
though poisonous ones are followed first, 
by paralysis and abolishing of the reflexes 
and then by tetanic seizures and increases 
of reflex function. The respiratory cen- 
ter is stimulated by large doses, while those 
of toxic quantity are followed by paraly- 
sis of this function. Aside from the in- 
creased kidney and bowel action, atropine 
acts to decrease all glandular function. 

Taking up strychnine, we find that it 
stimulates practically every function. 
Medicinal doses serve to powerfully stimu- 
late the circulation, through action upon 
both the heart and vasomotor center. The 
pulse is strengthened and becomes more 
active after the establishment of the drug 
action. Toxic doses of the drug lower 
blood-pressure through depression of the 
vasomotor center, but even after poison- 
ous doses, with tetanic spasm, the blood 
pressure will be found increased, due to 
muscular activity. With the possible ex- 
ception of the action of toxic doses in the 
paralysis of the efferent, or motor, fibers, 
strychnine is found to be the most power- 
ful stimulant we possess, in its action upon 



the nervous system. It is a powerful 
stimulant to the cord, especially the motor 
centers thereof. Even in poisoning the 
reflexes are exaggerated, the least excita- 
tion being followed by tetanic seizures, as 
a rule. Strychnine stimulates the eye, in- 
creasing acuteness of vision. Respiration 
is quickened and deepened through the 
stimulation of the respiratory center in a 
powerful manner. This drug stimulates 
all of the functions of the entire alimen- 
tary canal, increases the flow of gastric 
juice, the muscular movements of the gas- 
tric muscles, and intestinal peristalsis. 
Through the central nervous system, it 
increases uterine function, acting to over- 
come inertia of this organ. In fact, with 
the exception of the depression of the ef- 
ferent or motor fibers of the cord, follow- 
ing toxic doses of the drug it is clearly 
seen that every action of strychnine is 
stimulating. 

After considering both drugs carefully, 
with the possible exception of stimulation 
of the circulation, one can hardly see why 
atropine should be preferred to strychnine 
as a general stimulant. Strychnine is 
never, in medicinal dosage, a depressant, 
whereas atropine frequently possesses such 
action. Atropine, while it may act to stim- 
ulate the circulation may, if continued 
over a considerable period, act reversely, 
due to accumulation of the drug. The 
stimulant action of strychnine is invariably 
increased if the cumulative effect of the 
drug follows. The invariable possibility 
of cumulative effect of atropine makes this 
drug dangerous, if administered over any 
very considerable period, in that paralysis 
of the inhibatory centers may render the 
elimination practically nil. Although there 
may be accumulation of strychnine, after 
a considerable period of administration, the 
eliminative functions are not interfered 
with, and if the drug is withdrawn, or the 
dose decreased, the cumulative effects will 
disappear. 

After a careful consideration of both 
drugs it is a difiicult matter for one to de- 
termine why atropine should ever be em- 
ployed as a stimulant, instead of strych- 
nine. Primarily it is a dangerous drug, as 
well as a tricky one, and no one knows 
just what to anticipate when it is used 
over any considerable period. It is valua- 



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THE MEDICAL SUMMARY 



ble under certain circumbtances, but even 
then, it bears watering every moment. 
It is valuable when w^e desire prompi 
stimulation of the vasomotor center, but 
then a smgle dose usually suffices to gain 
the desired end. The facts of the matter 
seem to be that this agent should be em- 
ployed, as a rule, for its antispasmodic, 
rather than its stimulant ettect. Strych- 
nine is a dependable drug; one free from 
trickery of action, as a rule; one that in- 
variably gives the eitect anticipated; one in 
which cumulation is not necessarily a mat- 
ter of grave importance, in so tar as dan- 
ger may be concerned. 

Employed in the face of certain indica- 
tions, atropine is a most valuable agent, but 
not as a general stimulant to be used over 
a considerable length of time. Strych- 
nine is equally valuable, when employed as 
indicated, and may be employed for a con- 
siderable time as a stimulant, without fear 
of dangerous effect. The facts of the matter 
are that, on every count, strychnine is the 
preferable agent when one desires a stim- 
ulant, pure and simple, as that is the domi- 
nant action of the drug in medicinal or 
larger doses. 

Gardnerville, Nevada. 



AMPUTATIONS. 

By J. L. Wolfe, M.D. 

An amputation may be accidental, as 
when a limb is torn, cut or crushed off by 
machinery, natural as in senile gangrene" 
from gradual failure of the heart, or pa- 
thological changes in the arteries, the dead 
portions are separated at the line of de- 
marcation, or surgical when scientifically 
performed. 

When in amputation the line of section 
is through the substance of the bone, the 
operation is said to be in continuity; and 
when through an articulation incontinu- 
ity, the removal of the part which is use- 
less or deformed, the presence of which, 
"-"^wever, does not threaten the life of the 
Individual, is called an amputation of ex- 
pediency; under more urgent conditions 
the operation is one of necessity. Ampu- 
tations of necessity are further subdivided 
into those after disease. 



In amputations after accident, the period 
in which the operation is performed is di- 
vided into the immediate, primary and sec- 
ondary. An immediate amputation is per- 
formed during the prevalence of shock, 
and usually within from two to six hours 
after the injury necessitating the opera- 
tion; primary after reaction from shock 
and before inflammation is established, 
usually within twenty-four hours after the 
injury; secondary when performed after 
the limit and during the prevalence of in- 
flammation. 

The danger of death after amputation 
depends chiefly upon the character of the 
injury and the location of the line of sec- 
tion. The prognosis becomes dangerous 
in proportion to exhaustion of the patient 
as a result of hemorrgage, shock, sepsis 
or of any dyscratia or intercurrent diseai^e. 

As to the line of section, there are prac- 
tically no exceptions to the law that the 
rate of mortality is proportionate to the 
diameter of the part divided and the prox- 
imity of the section to the trunk. Thus, 
amputations of the lower extremities are 
more fatal than those of the upper. Those 
of the hip more fatal than through the 
middle and lower third of the leg, while 
the same comparison holds good from the 
shoulder out. As to the age of the patient, 
it may be said that the death rate gradually 
increases with each decade of life. 

Operation of expediency, when properly 
performed, may be considered as practically 
free from danger for the reason that the 
general condition of the patient is good 
and the section through clear and healthy 
tissues. Amputations after non-malig- 
nant diseases, such as destructive ar- 
thritis and osteitis, are comparatively free 
from danger, provided that general sepsis 
and consequent exhaustion have not oc- 
curred prior to the operation. Amputa- 
tions necessitated by malignant neoplasms 
are especially dangerous only in proportion 
to the degree of malignancy in the tumor, 
together with the general deterioration of 
the tissues as a result of the prevailing 
cachexia. Amputations after accidents 
are most fatal, and statistics show that 
primary operations are, in general, more 
dangerous than those done in the secon- 
dary period. 

Amputations are much less frequent now 



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than formerly, and there is little doubt 
that in the present rapid advancement in 
the science of surgery, and the greater 
pertection in the art, the time is not tar 
distant when amputation for other causes 
than gangrene will be comparatively rare. 
Very few deformities would lead to the 
amputation, if at first the services of a 
skilled surgeon were obtained. And this 
is equally true of the lesions of the joints 
and bones, for which the necessity of am- 
putation would be exceptional, if at the 
earliest symptoms of the disease the 
proper treatment was instituted. 
Cedar Falls, Iowa. 



CAUSE OF APPENDICITIS. 

By a. Charbonxeau, M.D. 

That appendicitis is nearly always due to 
improper living, is a fact known the world 
over. It is indeed rare for young children, 
especially those fed on an exclusive milk 
diet, to suffer with the disease, when 
properly fed. 

Young children begin to suffer from ap- 
pendicitis after the second year of life, 
when they begin to take solid foods. The 
careless, inexperienced young mother will 
make particular efforts to induce the chil- 
dren to eat all kinds of food that is placed 
upon the table for adults. She stuffs the 
innocent youngster with a lot of indigesti- 
ble food, which is usually improperly 
cooked and seasoned. 

The mother does not stop to realize 
that the little child has only a small, deli- 
cate stomach, which is unfit for a large 
amount of solid food. She therefore al- 
lows the child, who has its little hands ex- 
tended in frantic efforts to take any arti- 
cle, a potato, a dry cookie, or ice cream 
and what not, a lot of indigestible food 
which is very harmful. Mastication of 
the food is essential before proper diges- 
tion goes on. The mother does not realize 
these facts until she has taught the child 
the habit of overfilling its little stomach 
with all kinds of food stuff that is handed 
off the table. 

The stomach is never given the proper 
amount of rest. When the child begins 
to complain of stomach disturbances, it is 



severely punished by a heroic dose ot 
caaior oil, tucKed to bed and allowed to 
sutler from an inflammation of the btom- 
acn and intestines. 

A child's stomach does not tolerate all 
the food stuff that is ingested by an adult. 
Even in adults certain kinds of food are 
not well tolerated by the stomach. Why 
should they be allowed to children? 

So far as my observation and opinion 
thence derived goes the condition is nearly 
always primarily an overloaded stomach 
and bowel. The intestines become filled 
with a variety of indigestible foods, often 
in excess, consequently setting up on irri- 
tation near the appendix and thus gradu- 
ally causing an inflammation of the organ. 

All attacks of appendicitis are preceded 
by a chronic inflammation of the bowel. 
I do not remember of ever having seen a 
case of the disease which occurred in a 
person with a well regulated condition of 
the stomach and bowels. It is almost im- 
possible for the disease to develop as there 
is an utter incompatibility between a clean 
bowel and an appendix. 

Twelve per cent, of the cases of appendi- 
citis we surgeons are called upon to oper- 
ate have been caused from foreign sub- 
stances which have been swallowed and 
lodged in the organ. Of the numerous for- 
eign substances which have been found, I 
may name fish bone, bristles, apple cores, 
seeds from various fruits, concretions, pins 
and even gall stones. These substances 
have been the cause of the most severe 
cases of appendicitis. 

Nearly fifty per cent, of the people who 
have had appendicitis contracted the dis- 
ease from disorders of digestion. Diges- 
tion and constipation were strong predis- 
posing causes of the disease. 

Forty per cent of the people who suffer 
from constipation have contracted appendi- 
citis, and had to be operated upon sooner 
or later. 

The explanation of this fact is that the 
bowel becomes overloaded with unsuitable 
food which accumulates into a hard mass 
near the appendix, pressing on that organ 
setting up an irritation, and along with the 
inflammation which was caused by the ac- 
cumulation of germs and products of de- 
composition, appendicitis resulted. 

Appendicitis is a disease which is un- 



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common in old folks, because their diet 
consists of the plain foods, taken in mod- 
eration. They are on the alert to correct 
digestive disturbances and take particular 
attention to keep their bowels regular. 

The colored people of the South very 
seldom have appendicitis, because their 
diet consists of plain and easily digested 
food. 

They take particular care to eat moder- 
ately and take a great deal of out-door ex- 
ercise and are comparatively free from 
digestive disturbances. 

Greenbay Wis. 



PATIENT DEVOTION. 



By E. S. McKee, M.D. 



Poor in purse, poor in knowledge, poor 
in experience, and poor doctor to the 
Thirteenth Ward was the writer in 1883. 
Said ward is that part of Trans-Rhenish 
Cincinnati which has Findlay Market for 
its court of honor. This locality is bi- 
sected by Pleasant Street. Why so named 

I do not know, certainly not from its ap- 
pearance. I was called to that part of 
Pleasant Street south of Findlay Market 
to see Anastasia Lemkuhl. That was not 
her name, but it will serve to indicate her 
descent and her accent. The illness and 
the treatment were without event of mo- 
ment, but this was the start of one of the 
most remarkable cases of devotion of a pa- 
tient to her physicion that it has ever been 
my lot to meet. The party in power which 
made me physician to the poor of the un- 
lucky Thirteenth remained in power for 
three years. My successor could never 
touch Anastasia. She moved frequently. 
Bank, Dunlap, Elder, Elm, McMicken, 
Pleasant, Race, Stark. She often changed 
her residence, but never changed her doc- 
tor. It is the women who make or mar 
the young doctor. She brought me her 
children, grand children, parents, uncles, 
aunts, cousins, her in-laws, friends and 
neighbors. She had four children, two 
boys and two girls. The father of these 
children I never saw. In my long ac 
quaintance of more than a quarter of a 



century 1 heard only in rare instances a 
complauit irom the children about their 
lather, never one from their mother. 1 
know not whether he be alive or dead. It 
reminds me of the little girl's talk to her 
kitiy. "Kitty, I knows your brothers, and 
Kitty, I knows your sisters and your 
mother, but, Kitty, I never did see your 
father." 

Rumor said, but it matters not what ru- 
mor said, she remained true to her church 
and clung to the cross. How well do I re- 
member the oldest child, a skinny little girl 
of ten years, when she had typhoid fever. 
Fearing contagion, every one deserted her 
bui her mother, who watched over her day 
and night for four weeks, fearing in her 
delirium she would jump out of that 
fourth-story window. Thanks to the 
faithfulness of the mother, the daughter 
recovered and is now a fine-looking ma- 
tron. During the years that followed fre- 
quent illnesses of herself and children 
were paid for. I well remember the cold 
and snowy winter of 189 1-2, when la- 
grippe first made its appearance among 
us. She and I, like almost every one else, 
had frequent attacks of 'grippe. I did not 
then know how to best treat it or I would 
have been at home in bed instead of going 
about trying to treat it. Neither of us did 
well, but were sick off and on all winter. 
It was during this period that I ran up a 
bill of fifty dollars against her. Former 
ones had been small and promptly met. 
She was always a poor woman, and this 
one staggered her. The bill stood for four- 
teen years unpaid, though numerous small 
ones contracted in the meantime had been 
paid. I had not sent her a statement for 
ten years, when one day greatly to her 
joy she paid it. Fifty dollars after four- 
teen years. I am sure it gave her more 
joy to pay it than it did me to receive it. 

Anastasia in reply to my upbraiding her 
on the street one day for not having sent 
for me for several months, said: "Well, 
you see, I bought a stand in market, and 
when the children gets constipated I gives 
them oranges, and when they have diar- 
rhea I gives them peanuts." Suggestive 
therapeutics. During the many years after 
that she stood in market she never failed 
at my numerous visits to her home to try 
to fill my pockets with fruit and vegetables. 



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I often took them, found a quiet spot and 
unloaded. 

Teddy was the youngest child, and after 
a. long and severe illness he died, greatly 
to the sorrow of his devoted mother. His 
death never for a moment shook his moth- 
er's faith in her family physician. 

irlenny was her oldest son. She loved 
Teddy, but she both loved and admired 
Henny. He was 25 and and weighed 230 
pounds. The idol of his mother's eye, 
more especially since the death of Teddy. 
As driver for a brewery, he never shirked 
his duty, but was always ready to haul a 
double load. Called to see him I found a 
temperature of 104.6 and the patient out of 
his head. He had been ill for two weeks 
but had kept about his work. The diag- 
nosis of typhoid fever was easy. The 
disease went from bad to worse, character- 
ized by miningeal symptoms, insanity and 
very high temperature. Matters began to 
look: serious, consolation was suggested 
and the priest came. At eight A.M. he 
started Henny to saying the Lord's Prayer, 
and he could not stop him. He kept get- 
ting louder and louder till you could hear 
him a square, and the voice sang back at 
you from the ceiling. I could occasionally 
change him from English to German, but 
say the Lord's Prayer he would time after 
time at the top of his voice. Four men 
from the brewery who had been sent over 
to hold him, vanished one by one. Too 
much of the good thing gets on your 
nerves, and with the assistance of Dr. 
Khoun, who lived hard by, we administer- 
ed chloroform. It took a great deal to 
affect him. His voice would slowly and 
stubbornly die away imder the influence of 
the anesthetic, when he would go off in 
opisthotinQS. Removal of the chloroform 
ivould be followed by a resumption of the 
Lord's Prayer, becoming louder and 
louder till in a few minutes we would 
again have that echo singing back from 
the ceiling. Chloroform was repeated 
-with a return of the opisthotinos and it 
-was again removed. This condition con- 
tinued until half-past two, when Henny 
died saying the Lord's Prayer, which he 
had been shouting constantly, unless pro- 
foundly under the influence of chloroform, 
since eight that A.M. There he lay dead, 
his huge frame outstretched upon the bed, 



and beside me at the foot, gazing down at 
her dead son, stood his mother, speechless 
and tearless in great grief. At last 
speech came to her, and this is what she 
said: "Dr. McKee treated my Teddy and 
he died; Dr. McKee treated Henny and 
here he lays dead. When I am sick Dr. 
McKee will treat me, and if I die it will 
be all right." An almost unparalleled in- 
stance of devotion of a patient to her phy- 
sician. Believe me, she kept her word. A 
few years later a tired artery in her 
weary brain, which had known little but 
sorrow, broke. I was called and treated 
her through a long and serious illness, at 
the end of which she was laid to rest on 
our western hills, between Henny and 
Teddy. 

A few years ago I was called to see 
little Carrie, fourth generation of this 
family, a descendent of Anastasia, through 
her mother. Said mother had married 
neither too wisely nor too well. I had 
treated little Carrie all her life, and she 
hardly thought there was another doctor 
in Cincinnati. She had tonsillitis, then 
rheumatism, then endocarditis. On one of 
my visits the mother met me at the door 
with tears in her eyes and told me that 
Charley, her husband, was an Eagle, and 
he had sent for the Eagle doctor, whom he 
could get for nothing, and he wouldn't have 
me any more, and that the Eagles doctor 
had said that Carrie had St. Vitus' dance. 
I danced out, fired by the fourth genera- 
tion. I have not been able to collect my 
bill. 

Herein lies the tonnage of my text. The 
Eagle doctor is a member of the Academy. 
A few years ago a member of this society 
read a paper on the subject of contract 
practice. The paper was a good one, 
led to quite a discussion and the 
passage of resolutions by the society con- 
demning the practice and making it in- 
cumbent upon its members, who were em- 
ployed in this way, to desist. The member 
who read this paper has left town, but I 
hope that the good work which he started 
with such force will not be allowed to fall. 

Grand and Nassau Streets, 
Cincinnati, Ohio. 



Wrist-drop in fractured humerus means 
involvement of the musculo-spiral nerve. 



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SOME SUMMER REMEDIES AND THEIR 
INDICATIONS. 

By H. Hamilton Redfield, A.B., M.D. 

Professor of Therapeutics in the Bennett Medical 
College, Medical Department of The Lyola Uni- 
versity, Chicago, 111. Chief Therapeutist 
to The Jefferson Park Hos- 
pital, Chicago, III. 

Colocynthin is an active purgative glu- 
cobide, derived from colocynthis (common 
name, bitter cucumber), a vine of the nat- 
ural order of cucurbitaceae. Dose of the 
standard granule, 1/134 grain. 

Physiological Action. — Colocynthin acts 
as a hydragogue cathartic, producing pro- 
fuse stools, which may be attended with 
griping pains. . 

Therapeutics. — Colocynthin. is the indi- 
cated remedy in cholera morbus, and in di- 
arrhea when attended with pains aboxit the 
region of the umbilicus which are twisting 
and griping, and which cause the patient 
to bend over the back of a chair, face 
downward or press firmly against the ab- 
domen with his hands. The partaking of 
food or drink, in these cases, only tends to 
aggravate the pains. A temporary relief 
is afforded by the discharge of stool or 
flatus. 

Colocynthin should be studied in neu- 
ralgia which may be confined to the tri- 
geminus nerve, and attended with tooth- 
ache and hemicrania. 

But the chief indication is when the sci- 
atic and crural nerves are involved, and 
when the pains in the hip give a sensation 
as though the bones forming the joint 
were being screwed together. There are 
pains which dart down the left leg with 
the rapidity of lightning to the popliteal 
fossa. 

Women who are sufferers from ovarian 
neuralgia, when the typical twisting, 
griping pains, which come and go at inter- 
vals and which cause the patient to bend 
double are present, find a comforter in 
colocynthin. 

Colchicine. — Colchicine is an intensely 
bitter alkaloid derived from colchicum 
autumnale (common name, meadow saf- 
fron), a plant belonging to the natural or- 
der of liliaceae. Dose of the standard 
granule, 1/134 grain. 



thysiological Action. — Colchicine be- 
longs to the drastic purgatives. It is also 
an emeto-cathartic, diuretic, diaphoretic, a 
caraiac depressant, and gastrointestinal ir- 
ritant. 

in small doses it causes an increase in 
the secretions, especially of the urine and 
perspiration. 

m full doses it acts as an emetocathartic, 
being productive of profuse watery stools, 
nausea and vomiting, with great muscular 
feebleness. 

In toxic doses it is a powerful gastroin- 
testinal irritant. There is griping; the 
stools are similar to the choleric stools; 
arterial tension is lowered, and by reflex 
action over the pneumogastric nerve, the 
heart is slowed. This is followed by great 
prostration, convulsions, and finally by 
death, with full consciousness until carbon- 
dioxide narsosis ensues. 

The question as to whether or not col- 
chicine has any effect upon the excretion 
of urea or uric acid is still in dispute, but 
there is quite a little clinical evidence to 
the effect that it does increase the amount 
of bile and the total excretion of urinary 
solids. 

Therapeutics. — ^The great field of col- 
chicine seems to be in patients of a rheu- 
matic or gouty diathesis, where its action 
is specific. It should be given, preferably, 
in conjunction with alkali, and the patient 
brought just to the verge of emetocathar- 
sis. 

Murrell strongly advocates the exhibi- 
tion of colchicine in cases of gout. In 
these cases he gives colchicine in doses of 
1/60 grain, together with a grain of calo- 
mel, every three or four hours. The same 
author has this to say regarding this drug: 

"Colchicine, which is an alkaloid with an 
acid reaction, although comparatively lit- 
tle used in medicine, is a most valuable 
remedy in doses of from i/ioo to 1/32 of a 
grain. It has a marked physiological ac- 
tion, producing in large doses motor and 
sensory paralysis, with death from respira- 
tory failure. Its action is curiously de- 
layed, there being a latent period from one 
to three hours. It expels the leukocytes 
from the circulation, collecting them in the 
bone-marrow. After a time they return to 
the peripheral circulation, and it is then 
found that there is an increase in the white 



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cells, especially the polymorphonuclear vari- 
ety, it IS possible that in this curious action 
may be louna a ciue to its beneficial action 
in gout. Colchicine sometimes increases 
the riow of urine slightly but has been 
known to produce anuria of many hours' 
duration. Colchicine salicylate may be 
given in doses of 1/60 grain. It is soluble 
in water." 

This alkaloid is indicated in cholera mor- 
bus when the stomach is cold and clamy 
and nausea and prostration are present 
The stools are bloody, with white shreddy 
particles, and the tenesmus is extreme. 
Here the dose should not exceed 1/500 
grain every two hours. 

In ascites that is secondary to. some ob- 
structive disease of the liver the exhibition 
of colchicine, in connection with cactin, 
strophanthin, or some of the other excel- 
lent heart remedies, gives most happy re- 
sults. 

Its action as a depletor of the portal 
circulation gives it a prominent place in all 
portal congestions, when if given with . 
saline laxative or sodoxylin its action is 
magical. 

It should be studied in cerebral conges- 
tions of the acute type, when its action 
as a revulsive purgative makes it most ef- 
fective. 

In addition to colchicine being the rem- 
edy "par excellence" in gouty conditions, 
it is especially indicated in those cases of 
gout when the least touch or jar makes the 
patient wince with anguish, and the great 
toe and heel are especially tender. The 
pains, here, are of a migratory nature, and 
are worse at night. 

Compare macrotin, chelidonin. collinso- 
nin, leptandrin, podophyllin, bryonin. 

Gelseminine. — This is one of the two 
alkaloids derived from gelsemium semper- 
virens (commoon name, yellow jasmine), 
a climbing plant of the order of logan- 
iaceae, and indigious to the Southern States. 
Dose of the standard graunle, 1/250 
grain. 

Physiological Action. — Gelseminine is a 
motor, and respiratory depressant, its ac- 
tion being manifested on the anterior cor- 
nua of the spinal cord and the respiratory 
centers. The exhibition of gelseminine in 
small doses is productive of a slowing of 
the heart, feebleness of action, impaired 



sensibility, leebie mubcular action, lan- 
guor, dilated pupils, drooping of the eye- 
lids, and some diaphoresis. 

In toxic doses geli^eminine produces ver- 
tigo, diplopia, dilated pupils (due to par- 
alysis of the third nerve), labored breath- 
ing, the heart slows and grows feeble, the 
jaw drops, gait is staggering, there is ex- 
ceeding mubcular weakness, profuse svveat- 
i"gf> general anesthesia, loss of speech, 
ending in death due to paralysis of the 
muscles or respiration, consciousness be- 
ing maintained until the onset of carbon- 
dioxide narcosis. 

While gelseminine lowers the rate of the 
heart-beat, it does not act as an arterial de- 
pressant, neither has it any irritating ef- 
fect upon the gastrointestinal tract. Given 
in moderate doses, the effects pass off in 
about three hours. Gelseminine produces 
a decided lowering of the body-tempera- 
ture. 

Therapeutics, — Gelseminine is the indi- 
cated remedy in all cases of exalted nerve 
function, and is contraindicated whenever 
a weak heart exists. Nervous women, 
children and young persons seem to be es- 
pecially susceptible to the action of gel- 
seminine, including those who complain 
of being "all tired out" or "run down." 

It is of service in onanism both in the 
male and female; also for hysterical wo- 
men, especially when the patient has 
spasms and complains of a sensation as of 
a lump or ball in the throat (globus hys- 
tericus), palpitation of the heart, the ex- 
tremities numb as though paralyzed, the 
urine profuse and clear, and the patient 
apprehensive and worried. 

In cerebrospinal fever, when the pa- 
tient is apathetic or lies in a stupor, with 
a tendency to convulsions, delirium, and a 
bruised feeling all over the body, gelsemi- 
nine gives excellent results. 

The remittent and intermittent fevers of • 
children, when the nervous symptoms are 
marked, are much benefitted by gelsimi- 
nine. 

In all fevers which are characterized by 
marked nervous symptoms gelseminine 
should be the remedy of choice. 

It should be remembered in congestive 
headaches, as well as those of neuralgic or 
reflex type, which begin in the cervical 
region and extend up over the top of the 



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THE MEDICAL SUMMARY 



head, there being a sensation of fullness or 
bursting across the forehead, and the eyes 
feel as though they were being pushed out 
of the sockets. The patient is completely 
relaxed, and there is great muscular pros- 
tration. 

During confinement, when the os is rigid 
and labor retarded, with the patient highly 
nervous, the exhibition of the gelseminine 
together with caulophyllin will be pro- 
ductive of the best results. 

Relaxed, irritable and cold genitals in 
the male call for gelseminine. There are 
nightly emissions without an erection, and 
the patient does not awaken from sleep 
when ejaculation takes place, but awakens 
in the morning to find the night clothing 
stained and himself completely exhausted 
and nervous. 

In mania, when the motor excitement is 
great and the patient a sufferer from per- 
sistent insomnia, gelseminine gives relief. 

In pneumonia or pleuritis, provided the 
action of the heart is not weak — which 
would contraindicate its use — gelseminine- 
to full physiological effect is one of the 
best remedies. 

In coughs which are convulsive or spas- 
modic in character, gelseminine should be 
given attention. 

A full dose of gelseminine at bedtime 
will often abort a coryza. 

It finds a sphere of usefulness in the 
treatment of neuralgias, especially those 
affecting the fifth nerve. 

Any strong emotion, such as fear or 
fright, bad news, etc., which might pro- 
duce exhaustion or muscular weakness, 
indicates gelseminine. 

In delirium tremens and insomnia its ex- 
hibition has been followed by a disappear- 
ance of all the symptoms. 

After-pains of labor are frequently stop- 
ped by gelseminine in full doses. 

Incontinence of urine, due to a paralysis 
of the vesical muscle-fibers, in women and 
children, is relieved by gelseminine. 

It has no equal in ovarian neuralgia. 

The pains of dismenorrhea often are 
relieved by gelseminine. 

It is the first remedy to be given thought 
in prostration and exhaustion due to ex- 
posure to the sun*s rays; although, if in 
these cases the congestion is very marked, 



glonoin will give better and quicker re- 
sults. 

Paresis and paralysis occurring as se- 
quels to diphtheria are combatted by gelse- 
minine; and it is often the only remedy 
that is needed in these cases. 

The acute inflammatory fevers of child- 
hood demand gelseminine. These patients 
present a marked nervous condition, with 
eyes bright, pupils contracted, while a high 
slate of nervous tension exists. 

Compare its action with that of atropine, 
veratrine, cicutine, and hyoscine. 

622 W. 71st St, Chicago, Illinois. 



BAUNSCHEIDTISII. 
By J. A. Burnett, M.D. 

Most of the medical profession do not 
know anything about Baunscheidtism or 
what is also known as the exanthematic 
method of cure. This is a system of treat- 
ment that is used more by the laity, espec- 
ially by Germans, than by physicians, pos- 
sibly because it is simple to use and does 
not possess much curative influence. 

No matter about the results from 
any form of treatment or whether it is 
recognized as being of any value or not, 
all well-informed physicians should know 
something about it, especially if it is some 
method that is familiar with a great mass 
of the general public, for any layman 
would think a physician ignorant if he 
did not understand all methods of treat- 
ment. Baunscheidtism or the exanthe- 
matic method of treatment is an exter- 
nal method of treatment accomplished 
with an instrument and an oil. The 
instrument is about lo inches long and 
nearly an inch in diameter at the large end, 
and tapers to a sharp point at the other 
end. The large end contains 30 fine need- 
les fastened to a spring arranged so by 
pulling the small end of the instrument and 
letting it loose they all pierce the skin at 
one time. The action of the spring is so 
quick that the needles do not cause any or 
much pain even when force enough is used 
to cause blood to ooze out of the needle 
holes. The oil is put on the surface punc- 



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tured by the needles. Some put it on 
before puncturing and others put it on 
after the puncturing. This puncturing is 
applied over any part of the body, usually 
in localities where counter-irritation would 
be used, and is of no doubt of some value 
in cases where counter-irritation is indi- 
cated. 

The imported instruments and oil can be 
obtained and the imitations are made 
and sold by several houses in the Uni- 
ted States. The instrument used can 
be purchased for $1.50 to $5.00. It is 
called lehenswecker or resuscitator. The 
oil is a secret or sold as a secret by 
all houses, each claiming theirs to be 
the best. It is sold for 50 cents to $1.75 a 
bottle of about one ounce size. When the 
treatment is given with the instrument and 
oil, sooner or later, small millet seed-like 
blisters appear filled with a yellowish fluid, 
which is said to be the poison from the sys- 
tem. It is claimed that if a person is in 
perfect health this eruption will not appear. 
This is claimed both as a test from health 
and as a proof of this form of treatment 
being of value. The advocates of this sys- 
tem of treatment claim the chief seat of 
every dangerous disease is in the spinal col- 
umn, and they always treat the spine in 
severe cases. The treatments are given 
at>out every fourteen days, except in rare 
cases. This gives time for the vesicles, 
pustules, etc., to dry up and peel off. 

John Linden, of Cleveland, Ohio, is au- 
thor of a ''Manual of the Exanthematic 
Method of Cure," a cloth bound volume of 
over 400 pages, and passed through over 
20 editions. It is published in both English 
and German. John Linden also sells the 
instrument and oil, as well as his book. 

Carl Baunscheidt, a German, was the 
founder of this system of cure known as 
the exanthematic method, or Baunscheidt- 
ism, after his name, or at least it was his 
influence that brought it into such general 
use. John Linden gives credit to Dr. Fer- 
dinand Schrattenholz for the first impulse 
of the present instrument, and traces the 
history back for centuries in China and 
Japan, and in a work published in France 
in 1694, also back to the American Indians. 

The oil used by C. Baunscheidt, of Bonn, 
was held as a secret, and as he has been 



dead for several years there is no way of 
finding out what it was. According to 
Hagar (Arends Spezialitaten und Geheim- 
mitted), Baunscheidt's oil consisted of 

^ Euphorbium i part 

Mezereum 3 parts 

Alcohol I part 

Olive oil 20 parts 

According to Hoffman it consists of 

5^ Euphorbium 5 parts 

Cantharides 3 parts 

Olive oil 100 parts 

Another supposed formula is 

5t Croton oil i part 

Olive oil 100 parts 

There are but few articles in medical 
journals on the exanthematic method of 
cure. I have noticed a few queries in the 
journals regarding it. There is a valuable 
article on "Baunscheidtism" in January, 
191 1, American Journal of Clinical Medi- 
cine, by Dr. M. M. Cook, of Seattle, Wash., 
in which he says: "My preceptor. Dr. C. H. 
Blecker, was a finely educated German, 
who during his life made a specialty of 
this treatment. I learned the method of him 
in 1873, receiving the lehenswecker and the 
oil manufactured in Germany, and Baun- 
scheidf s book. {'Lehenswecker^ in English 
is rendered as 'resuscitator,' literally mean- 
ing life-awakener.' — Ed.)" 

Dr. Cook says the German instrument 
and oil are considerably more elegant than 
those made in this country. The resuscita- 
tor consists of a neat cylinder of hard wood 
for the outer part, which is a small instru- 
ment eight inches long. A round head of 
solid lead five-eighths of an inch in diame- 
ter and three-quarters of an inch long has 
one end set with twenty very fine sharp 
needles, while to the opposite side is at- 
tached a spiral brass spring running through 
the wooden cylinder and terminating in a 
wooden thumb piece. 

The book by Baunscheidt claimed the oil 
was made from the yellow ant of Germany. 
Dr. Blecken used three formulas as an imi- 
tation of the German oil, as follows : 

9 No. I : Croton oil 3ij. 

Olive oil 5vj. 

1^ No. 2: Croton oil 5iij. 

Olive oil 5v. 

^ No. 3 is made by putting six to twelve 
live honey bees in one ounce of prescription 



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No. 2, and agitating them until they are 
drowned. No. 3 was used in the worst in- 
fections of syphilis. 

Dr. Cook applies the oil before he uses 
the instrument It is applied with a soft 
brush and not rubbed. The instrument is 
then applied smartly surrounding the af- 
fected region, continuing the spiral toward 
the center. Rpeat say half a dozen times 
until the skin shows a pink glow. Cotton is 
placed over the parts treated and covered 
with bandage and not removed before the 
fifth day. Dr. Blecken repeated the appli- 
cation every fourteen days. 

Dr. Cook states: "Whether Baunscheidt 
was a regular physician or not I do not re- 
call, inasmuch as his book is not at hand. 
I do know, however, by seeing Dr. Bleck- 
en's work as well as from my own experi- 
ence ii\ many cases that the treatment will 
do what drugging internally often cannot 
do. It is not always practicable but in se- 
lected cases, as is true of all good reme- 
dies it is the thing.'* 

I found by corresponding with Dr. Cook 
that he considers the three formulas as 
given above by Dr. Blecken will do any- 
thing that the imported oil will do. The 
German imported oil must contain croton 
oil, as a small amount will quickly act as a 
purgative. The inhalation of it by giving 
several treatments a day will in some in- 
stances act as a purgative on the operator. 
Dr. Blecken would be purged similar as if 
he had taken a dose of croton oil when he 
was busy giving these treatments, is which 
led him to Suspicion croton oil in the Ger- 
man oil. The eruption produced by it will 
also prove that it contains croton oil. 

John Linden in his book says of his oil : 
"In cases of constipation, give seven to ten 
drops of the oil in an egg with water." 
This is evidence his oil contains about one- 
tenth part croton oil. 

In my early practice I found an old lady 
using croton oil locally for rheumatism, 
which she said gave her better results than 
anything she had ever used. I tried it in 
several cases of rheumatism, lumbago, etc., 
and with very good results. I found some 
were very susceptible to its influence and 
some are hard to effect with it. I applied 
5 to 10 drops pure croton oil locally once a 
day until it began to irritate. I know a 



physician that applies equal parts of croion 
oil and tincture of iodine on the chest in 
bronchial troubles. Tartar emetic is an- 
other drug that can be used locally for 
counter-irritation. It will produce vesicles 
like croton oil or Baunscheidtism. It has 
been used for many years on the spine in 
hysterical women, and for lumbago, etc. 

Dr. Cook places great confidence in the 
exanthematic treatment, and has tested it 
for many years. He writes me that any 
physician will be pleased with it who will 
give it a thorough trial. He knows of an- 
other physician who has used this method 
for years and places great confidence in it. 

Betz, as well as most surgical instrument 
dealers, can supply the instrument and oil. 

Marble City, Okla. 



MEDICAL ETHICS VERSUS HARPIES OF 
MEDICINE. 

By T. G. Stephens, M.D. 

The harpies are described in mythology 
as winged monsters, daughters of Nep- 
tune and Terra, names Aello, Celaeo, 
Ocypetes, with the faces of virgins, the 
bodies of vultures and hands armed with 
claws. In the medical profession we have 
an element, or rather a class, who are veri- 
table human harpies — we refer to the abor- 
tionist. This despicable class who have 
foistered into the medical fraternity re- 
semble nothing so much as the mythologi- 
cal harpies under the guise of being an 
honorable physician — a man who by the 
virtue of his pledge to use every effort to 
relieve human suffering and exert an in- 
fluence for good, wontonly tears down the 
greatest bulwark of virtue, and sows the 
seeds of death. Not only may the work of 
the abortionist end in speedy death or 
protracted ill health, but coupled with Kis 
work is immorality and license which is 
diabolical indeed. The abortionist is truly 
a cowardly murderer, and he should not be 
allowed to masquerade as a physician. He 
holds nothing in common with the medical 
profession, which in every cause is one of 
the noblest and most useful of callings. 
Every physician should report to the de- 
tective officers the names of abortionists, 
and use every means at his disposal to ex- 



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209 



terminate these harpies. In Great Britain 
the penalty for this is death, and in the 
United States the penalty was originally 
the same, but has been reduced to States 
Prison. 
Sidney, Iowa. 



NEPHRITIS. 



By William N. Wilson, M.D. 

Acute renal hyperaemia, or albuminuria, 
chronic, and occasionally subacute nephritis, 
and the uremias, constituting what is call- 
ed Bright's disease of the kidneys, but of- 
ten spoken of by physicians as a "complica- 
tion of diseases." 

Albuminuria or nephritis was looked up- 
on as one single disease by Bright, of Eng- 
land, its discoverer, but since that time, by 
the investigations of many physicians there 
have been found between twenty and thirty 
forms of this disease, arising at any age, 
from a child three months old, who died of 
anasarca, and it is found in youth, man- 
hood, middle age, and the aj^ed, who arc 
the victims and die of one of its forms 
when there is nothing else to die from, bar- 
ing accidental death. Every form of 
nephritis is always produced by acute renal 
hyperaemia, or congestion of the renal or- 
gans, which ordinarily run parallel or con- 
currently with primary diseases; the exan- 
themata, and all fevers and other ailments 
as skin^ affections, tuberculosis, etc., and 
is also due to premature age or depravity, 
or' it appears nonconcurrently ; that is, 
without any specific disease as the exciting 
cause; for nephritis comes on alone from 
degeneration of structures, and the kidneys 
are always implicated. 

The only way in which a person can tell 
that something is wrong with his kidneys 
is a febrile condition and by the color 
of his urine, which may be dark or may be 
of a whitish cast even weeks before he 
comes down with nephritis. As far back 
as 1880, the late Henry R. Baldwin, M.D., 
then one of the local surgeons of the Penn- 
sylvania Railroad, at New Brunswick, N, J., 
said to the writer that he "nearly always 
tested the urine of his patients for albumen, 
for the approach of pneumonia, pleurisy, 
and carbuncular diseases, to see if there was 



albumin in the urine, and especially when 
the impending diseases were delayed in 
manifesting themselves, for with some per- 
sons they are generally two or three weeks 
coming down before the disease reaches its 
acme. In the beginning or prodomata, 
the patient wears a somewhat sleepy look, 
or is affected by uraemic coma, and con- 
vulsions if a child, and if alubmin 
was found, they were sure to have one of 
these diseases. 

We see a fierce disposition aroused up 
in man, dogs, lions, tigers and serpents, 
who live mostly on animal food, which pro- 
duces the greatest amount of urea and uric 
acid, which are toxic poisons to the blood 
in some persons, overwhelming the nervous 
system by a brain or nerve storm, and they 
are generally cross and quarrelsome. The 
horse who makes his dinner of oats, with- 
out the corresponding working, is not ex- 
empt from pneumonia, if he gets chilled, 
and has nephritis with swollen ankles and 
heart disease, or is stiff and foundered in 
his old age. 

The kidneys are a part of the eraunctory 
system, and as sewers of the body are also 
sympathetic organs, highly endowed with 
sensitiveness as far as diseases are con- 
cerned, and are likely to be congested and 
take on any inflammatory disease that the 
body is attacked with. 

Nephritis may be due to accidental, spe- 
cific and pathological causes, due to sys- 
temic derangements and diseases, particu- 
larly to degenerative or constitutional 
changes and acute renal hyperaemia or con- 
gestion of the kidneys comes with the pro- 
domata of every known disease, propor- 
tionate to the severity of the malady, which 
is engendered or increased by infection or 
contagion as well as idiopathically or alone, 
and it is brought on by a failure of the 
kidneys themselves, or it is a constitutional 
disease, because the person's system is af- 
fected, first by that materius morbi called 
Bright's disease, which drags the kidneys 
into it, or the kidneys and constitution are 
jointly affected at one time by a derange- 
ment as senility or premature age. 

"There is no pain with this disease when 
it first comes on as a rule, but tenderness 
on pressure is obtainable by pressing with 
the hands on the loins, in acute nephritis," 



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THE MEDICAL SUMMARY 



but rarely ever in the chronic form in the 
kidneys. 

Nephritis is divided into the concurrent 
form and the nonconcurrent or degenera- 
tive form, and the concurrent form which 
does not run usually longer than the time 
limit of the primary diseases, as the exanth- 
emata, etc., but is always found running 
parallel to them, so that a person is ill of 
two diseases at once, and the patient usually 
gets well, providing that he does not get 
chilled or is guilty of no error of diet, and 
also that renal hyperaemia has not existed 
too long and has become chronic nephritis. 

What is nephritis, and what are the 
causes in the human subject, for other ani- 
mals, as the horse, has it, and is called 
"foundered,** and has swollen ankles in his 
old age, or sooner? 

Acute renal hyperaemia is an active de- 
termination of blood to the kidneys, which 
may get well or pass into the chronic stage. 

Passive renal hyperaemia or venous stasis 
is a retention or a retardation of venous 
blood in the kidneys, and is generally seen 
in trouble with the right side of the heart, 
and in chronic liver diseases, and both of 
these may last a variable time, even to thir- 
teen or fifteen years, and during this time 
it may degenerate into a subacute nephritis, 
then becoming suddenly worse with a 
uraemic attack, or from exposure, as the 
finale of the disease. 

A transitory congestion of the kidneys 
may exist and is manifested by a fever, 
acute visual disorders, stupor, and tempo- 
rary paralysis, and sometimes with convul- 
sions in children, but paisses away soon; 
but a person coming down with any severe 
disorder becomes uraemic as the disorder 
grows graver or to its height at the be- 
ginning, and he may reach the stage 
of uraemic coma and convulsions, a sleepy, 
comatose condition, and in the prodomata 
of severe epidemic influenza, etc., he can- 
not be aroused when it begins at its in- 
vasion, with a hot head, rigors, a high 
fever; and in a child, with convulsions, 
vomiting, strabismus and insensibility, in 
proportion to the lung trouble and the fatal- 
ity of the disease. Acute uraemia in fevers 
does as a rule recover permanently, and 
there are two kinds of nephritis, the putrid 
or the nondegenerative or the concurrent 



form, which includes the exanthemata, and 
the second is the nonputrid or nonconcur- 
rent or the degenerative form, which comes 
at any or all ages and usually fails to get 
well. 

Albumin appears as high as one per 
cent, in degenerative changes, notably in 
amyloid diseases, and a small amount of 
albumin is a safe guide to the gravity of 
the situation, but the sediment in the urine 
is rarely lo or 15 per cent, in bulk by tests, 
but there are in the various forms of neph- 
ritis blood casts, bacterial casts, false casts, 
pus casts, epethelial, granular, fatty, waxy, 
hyaline, cylindroids, and the casts and de- 
bris of scarlet fever and other infectious 
and contagious diseases. 

In abnormal urine, the sp. gr. in acute 
kidney disease is higher than 1020, which 
is normal, but in nephritis it reaches J025, 
1030 and even 1040, is scanty, turbid, 
thick and dark in the early part of the dis- 
ease, in acute diffuse nephritis, as in the 
early stage of scarlet fever and other in- 
flammatory fevers, while in irritation about 
one-half of the quantity or less is passed 
than in health; but in chronic kidney dis- 
ease as in interstitial nephritis, the sp. gr. 
is loio to 1016, and in amyloid disease it 
may be 1004 or 1006. 

'The watery parts of the urine are sc- 
created by the malpighian bodies in the kid- 
neys which lie in small sacs, the commence- 
ment of the uriniferous tubules, and the 
saline parts of the urine are separated from 
the blood of the venous capillaries which 
convey the blood back to the renal vein," 
and it is believed that the uriniferous tubes, 
by means of their epithelial lining, separate 
the urine from the blood of the vessels 
which are in contact with them." — Pocket 
Anatomy, by C. E. I sacs, M.D. 

The urine in nephritis is increased by a 
degeneration or a lesion of the pancreas; 
in cirrhosis of the kidneys, in amyloid or 
waxy kidneys, in cardiac hypertrophy, and 
in certain stages of nephritis, in hysteria, 
convulsions, and sometimes in gout, and in 
diabetes. 

The urine is decreased in acute nephritis, 
granular kidney, in chronic interstitial 
nephritis, cyanotic induration of the kid- 
neys, from cardiac defect and inflamma- 
tions. 



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The urine is suppressed in acute nephrit- 
is, in algid stages of Asiatic cholera, yellow 
and violent fevers, including pneumonia, 
enteric and typhus fevers, and in inflamma- 
tions; from shock and collapse, from in- 
ternal injuries as fracture of the liver, and 
in spleen and bowel diseases; in violent in- 
fluenzas, and by catheterization, and neph- 
ritis is often followed by uraemia, and death 
by taking anesthetics, as chloroform and 
ether, or it is brought on by hard drinking, 
by a protracted spree of two or three weeks, 
in which renal hyperaemia or acute neph- 
ritis may supervene or may go hand in hand 
with delirium tremens. 

There must be ^ disposition to nephritis, 
because a single inflammation of the kid- 
neys will not produce it, as a nephritic cal- 
culous formed in the healthy kidney and 
passing down the ureter will recover. 

In many cases nephritis steals on a per- 
son as a degenerate disease, as a thief in 
the night, and the urine is not apparently 
bloody, but when tested by heat and nitric 
acid it shows haematine, and the person may 
have passed through acute renal hyperaemia 
without noticing the color of his urine, only 
to be prostrated suddenly by uraemia, like a 
flash of lightning out of a clear sky, with 
a pain in the pit of the stomach which is 
indescribable, and usually dies or is found 
dead in the morning. 

Nephritis may be divided into the con- 
current form, that is coming on with the 
exanthemata, all fevers and diseases, etc.; 
and secondly as the nonconcurrent or the 
idiopathic nephritis coming on without any 
known causes excepting a degeneration of 
the body, an idiosyncrasy, a cachexia or a 
dysuria, or a growing depravity of the 
system, to a poison secreted in the person's 
system, undermining its vitality. 

There is usually with young persons in 
health an awakening in the morning, a 
puflFy swelling existing of the under eye- 
lids, and wrongfully ascribed to sitting up 
late, and to hard sleeping to make up for 
this, but this is due to a daily irritation of 
the digestive and renal organs which need 
hours of rest and recuperation, because of 
a voracious appetite; but the simple habits 
of life are required by those who desire to 
live to a green old age and not die prema- 
turely of the gout or Bright's disease in 



some of its forms, as arteriosclerosis. Our 
primitive ancestors were plain people dwell- 
ing in tents, who ate plain food, and there 
is no record among them of colonial plum 
pudding, fruit cake or mince pies with 
brandy or cider brandy in them, if they 
were made then, and the courses at dinner 
could be counted easily, instead of having 
a bill of fare, and they did not import their 
cooks from France, but could count their 
'*dubloons," their "psisacs," **talents" and 
"sheckels" by the peck measure ful, and they 
lived from three to nine centuries, and then 
died of old age. 

Albumin is excreted with mucin by the 
mucous membranes from the nares by a 
cold in the head ; from the bronchii in bron- 
chitis, the lungs in pneumonia, from the 
gastrointestinal tract in intestinal catarrh, 
and in cholera infantum and in chronic 
diarrhea, and probably the fatty acids are 
in excess of whatever the alvine dis- 
charges fall upon the skin they redden the 
buttocks by producing an unhealthy inflam- 
mation, an erythema; for the blood is lack- 
ing sufficient albumin to guard against this, 
and it is surmised that the blood at this 
time is thinner in diseases, and this quality 
permits the albumin to escape from the 
blood through the arterioles of the kid- 
neys, but nonconcurrent nephritis in one 
half of the cases implies a diathesis, a 
chachexia, a physiological degeneration or 
premature age, a disease of the albumen it- 
self in the blood. 

Albumin is present in the concurrent and 
nonconcurrent or degenerative diseases of 
the kidneys as a distinct disease, and it is 
much more of a disease than a simple ex- 
cretion of albumin, and coming to especial 
subjects, but a simple pyelitis can exist 
without the degeneration of nephritis, for 
often a calculus can form in the kidneys 
and pass down one of the ureters to the 
bladder, causing an inflammation by abra- 
sion, but it does not cause Bright's disease, 
showing that there must be a degeneration 
of tissue to cause it. 

Albumin does not appear in the urine in 
health, and is the signal of disease. The 
white of an uncooked egg is an answer to 
what is albumin, which is found in every 
organ in the body and in all fluids except- 
ing perhaps the tears and the normal urine, 



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THE MEDICAL SUMMARY 



and when in the urine it is a pathological 
substance of diseased conditions, and the 
albumin in the blood may be partially co- 
agulated by fatty acids from the body, for 
as a rule acids coagulate albumin as well 
as heat; but in fatal thermic fever or sun 
stroke the albuminous fluid coagulates in 
the blood, and in the water cushion upon 
which the brain rests, and this fluid be- 
comes disorganized, a waste material, path- 
ologically considered, and the residue of the 
blood becomes more fluid and its color 
changes to a bright red. In Asiatic 
cholera the vomitus and feces are flocu- 
lent which are poured into the intestinal 
canal, and are called "rice water dis- 
charges," because of the albuminous fluid 
which is coagulated by some chemical 
agency of the disease, and if the person 
lives a while it is the changes herein men- 
tioned which prevents convalescence. In 
yellow fever if the vomitus is black the 
blood is nearly acid and the prognosis is 
unfavorable, but if the vomitus is white it 
is favorable to recovery. 
2^ Carver St., Boston, Mass. 



PECULIAR SKIN TROUBLE— PRURITIS 
SENILIS? 

Douglas H. Stewart, M.D. 



The peculiar skin trouble mentioned in 
your columns recently by Dr. Davis, and 
commented on by Dr. Field, appears to me 
to be pruritis senilis, caused by wasting (or 
senile changes) in the skin whereby the 
terminal nerve filaments are no longer 
protected as they should be. There is at 
least loss of protection if not positive 
pressure. Taking off the clothing, expos- 
ing the skin to draughts or doing any- 
thing calculated to drive the blood out of 
the skin or render it more anemic (less 
swollen as it were) naturally lessen the 
protection which the skin may afford and 
expose the nerve ends to undue irritation. 
Among old women it must be very com- 
mon, as I have it as a complication to pro- 
lapsus, uterine cancer, etc. Should I not 
be able to relieve it my patient obtains no 
sleep, and the result of an operation may 
be fatal from sheer exhaustion. Ung. 



something or other is always dirty and 
commonly inefficacious. Two prescrip- 
tions I use almost daily with cream of tar- 
tar lemonade. That is, make a pint of 
good lemonade, with sugar if desired, put 
in a heaping teaspoonful of cream of tar- 
tar. This should be drunk daily in such 
quantities as the patient wishes, %, e,, all at 
once or in divided portions. 

Locally. — Let the patient rub in a mix- 
ture of equal parts chloral, camphor, and 
carbolic (say aa S0> Put it up yourself, 
for the apothecary is fairly sure to volun- 
teer the remark that "It will burn fright- 
fully." The psychological effect of which 
unfounded comment I have only been able 
to offset by touching a drop to my own 
hands or tongue, and then painting some on 
the patient's hand. If it really burned it 
might be well applied to the druggist's 
tongue with the idea that the resulting pain 
would keep that deceitful member still. 
However, the point is this, never pre- 
scribe it. and if you are compelled to pre- 
scribe for any reason, then use this: 

Borax 5j. 

Prussic acid 5ij. 

Aqua rosae ^viij. 

Finally, if you have such a case in a 
young person (say 1 8 to 50 years of age) 
watch for the first symptom of locomotor 
ataxia, in as much as it sometimes appears 
even before gastric crises in this disease. 
The only visible eruption is finger nail 
scratches. 

128 W. 86th St., New York Citv. 



THE JULY NUMBER OF THE SUMMARY. 

A Nevada subscriber, under date of Tuly 
i8th, wrote us as follows: 

'The July number of the Summary, even 
though the weather was so insufferably 
hot in Philadelphia, compares well with 
your mid-winter issues. 

"Give us more suggestions like the one in 
re str>xhnine and atropine, and we will 
keep the Summary full of ideas evenr^ 
month, be it in the winter or the summer." 



Frequent attacks of cold in the head in 
children is alone almost conclusive evi- 
dence of adenoids. 



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a CoodeM»i San— ry cl PrMlicd M^dkane. drawn horn die bert and 
m^ bbec k wiuownc oat hem the dietf . medical paiM of leal vahM. 



EXAldNE THE URINE. 

Every sick patient is entitled to thor- 
ough examination. Too often, however, 
an examination of the urine is neglected. 
This thought has been recently impressed 
by the revelations in several cases of dis- 
ordered health in which the symptoms 
were quite diverse. In each of these cases 
a single symptom, together with the facial 
expressions, led to an examination of the 
urine. One complained of an intense neu- 
ralgic headache, worse at night and upon 
lying down. There was also some gastric 
flatulence. Another complained of intol- 
erable itching about anus. The third uri- 
nated frequently, but not copiously, but the 
urging was imperative. The fourth expe- 
rienced an otherwise unaccountable fatigue 
and gastric distension. A fifth one had a 
sudden attack of cardiac palpitation, the 
heart also skipping every third beat. Urin- 
alysis revealed the presence of sugar in 
each of these cases. — Eclectic Medical 
Gleaner. 



HOW TO AVOID "TAKING COLD." 



Everyone "catches cold" — that means 
everyone at irregular intervals suffers 
from a simple cold to a severe pneumonia. 
A simple cold with acute nasal congestion 
is an unmitigated nuisance, while a severe 
pneumonia is one of the tragedies of physi- 
cal life. 

I believe I have found a way by which 
most "colds" can be conquered if fought at 
their birth. Some years ago a friend said 
to me, "when I feel a strong draught blow- 
ing on my bald head I always rub it hard — 
that brings the blood back, and so I avoid 
taking cold." Later on I noticed that 
sneezing is always followed by congestion 
of the face, especially in those who 
sneeze heartily — that is "Nature's way of 



bringing the blood back," said I, remember- 
ing my bald-headed friend. Acting on 
this principle, I have experimented suffi- 
ciently to know that ''bringing the blood 
back" does drive away "colds," and that 
sneezing is Nature's way of restoring (or 
trying to restore) the normal circulation 
when a surface anemia has been caused by 
surface chilling. 

Therefore, when the nasal mucous mem- 
brane is first congested, and one feels he is 
"taking cold," let him bend the body for- 
ward (as in picking up a pin from the 
floor) and "strain" gently till the face is 
red, then (in the erect position) try to 
breathe through the partially occuled nos- 
trils; repeat this process till the nostrils 
are freely open. Of course one should 
exercise and take hot drinks till that chfiiy 
feeling disappears, but that does not drive 
away the nasal congestion which so often 
introduces a severe cold. 

This new method of avoiding "colds" by 
bringing on forced nasal hyperemia, and 
following this by patient nasal respiration 
till the nostrils are freely open, "sounds 
silly," but after three years of practical 
experience, I have decided to publish this 
brief statement. — Dr, Richard Ellis, in 
Medical Record, 



A NASAL WASH. 



J. D. Grant writes that many persons 
who habitually wash out the nose with 
plain water contract a swelling of the 
mucous membrane. Relief comes when the 
customary washing practice is stopped. For 
treatment of this condition, a hypertonic 
solution, such as 50 per cent. Glauber's salt 
solution is effective, tending to deplete the 
mucosa. Even better results may be ob- 
tained from an isotonic solution, except 
when there is great dryness and ozena. In 
this condition a hypertonic solution should 



213 



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THE MEDICAL SUMMARY 



be employed, for instance, plain water with 
a mere trace of salt. Grant recommends 
the following for cleansing the nose in 
chronic rhinitis: 

5^ Sodii biboratis gr. xcvj. 

Sodii salicylatis, 

Sodii chloridi aa gr. xlviij. 

Glycerini lalxxij. 

Aqua mentholis ad. $y'}. 

For use, a teaspoonful of this mixture is 
placed in about one ounce of warm water. 
— Practitioner, 



TREATMENT OF ACUTE RHEUMATISM. 

Dr. John Laird, in The Practitioner for 
February, 191 2, dwells upon the necessity 
of using decalcifying agents in the treat- 
ment of rheumatism. The fibrous tissues, 
chiefly involved, contain a relatively large 
amount of calcium salts, and these one 
should endeavor to remove when in excess. 
The author points out that the remedies in 
vogue in rheumatism, viz., lemon juice, 
alkalies, and citrates, as well as sodium 
salicylate, all tend to act in this manner. 

In treating an acute attack Laird orders 
rest in bed.. clears out the bowels with a 
small dose of calomel followed by a saline 
(keeping them thereafter gently open each 
day), and gives the following mixture 
every three hours: 

^ Potassium bicarbonate 3ij. 

Tinct. aconite itr viij. 

Tinct. aurantii 5j. 

Aqua chloroform — q.s. ad. Jviii. 

M. Sig. — ^Add two tablespoonfuls to the 
same quantity of water in a tumbler, then 
add one tablespoonful of fresh lemon juice 
and drink while effervescing. 

The aconite should be discontinued after 
the first twenty-four or forty-eight hours. 
Between successive doses of the mixture 
the author gives pure sodium salicylate in 
sufficient amount to relieve the joint pains; 
but he relies chiefly on the effervescing 
preparation to "eradicate the poison." 

Fluids should be given freely; barley 
water acidulated with lemon juice is ac- 
ceptable as a drink. In addition to the use 
of decalcifying agents, calcium salts should 
be withheld. Hard water is therefore to 



be avoided, and milk should be omitted 
from the diet. Under this plan of treat- 
ment Laird avers that there is less likeli- 
hood of cardiac or other complications 
arismg. In chronic forms of rheumatism, 
he administers the effervescing mixture 
three times a day before meals. 



GASTRIC DISORDERS AlfD SMALL HEART 

A connection between a special set of 
gastric symptoms and a congenitally suiail 
heart would seem to afford a fit subject for 
skepticism; but the orthodiascope, which 
enables the x-ray operator to study the hu- 
man heart and its relative size while in 
action, and the electrocardiograph, which 
makes it possible to obtain records of ven- 
ous, arterial, and cardiac pulsations, have 
placed such a pathogenic relationship on a 
sound foundation. A fixed normal stand- 
ard of the dimensions of the heart having 
been established — ^the tables of Groedel, 
based on tracings in the upright position,— 
it became possible to identify as small, any 
heart which fell below the minimum meas- 
urements adopted as normal for the corre- 
sponding size and sex. We are not deal- 
ing with a new question as far as the exist- 
ence of microcardia is concerned, the 
founder of modern medicine, Laennec, and 
long after him Virchow, Wilhelm Muller, 
These, and many other authorities, having 
given it careful attention. But all their 
work was done either on the hearts of ani- 
mals or on the human heart only after 
death. The orthodiascope, on the other 
hand, has not only made it possible to study 
the morphological features of the question 
in living man, but also to identify the clin- 
ical phenomena which the presence of a 
small heart entails. — Adler *and Kriedel 
{Archives of Internal Medicine). 



IN HAY FEVER. 



5t Fid. ext. grindeliae robustae. 

Fid. ext. yerbae santae aa 3j. 

Aquae 3xj. 

M. Sig. — ^A teaspoonful every 20 min- 
utes till relieved, then at intervals of three 
hours till cured. 



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twmiam mmfht plaand toeoalH 



nrXESTINAL TROUBLES IN INFANTILE the babies, and I am sure this could not be 

LIFE. considered aseptic, nor in accord with the 

pure food act. Just think of the liability 

rj. «# J- I o to contamination in this disgusting method! 

Editor Medical Summary. ■ B^t I ^ave hinted enough on this line; let 

1 desire to say a few things concerning me now tell you something about a treat- 
the intestinal troubles in infantile life. I ment I feel safe in recommending, 
hardly think it necessary to occupy space Some years ago, I came across a pre- 
with a discussion of the etiology, nor even scription in the Medical World, which 
the bacteriologic problem in reference to proved to be an improvement on the old 
this pathologic condition; for the class of bismuth and Dover's powder camphorated 
Summary readers who appreciate applied tincture of opium treatment, so much in 
knowledge derived from the clinical ob- vogue thirty-five years ago. I should also 
servations of the physician, are already have enumerated in the above the hydrar- 
posted on the theory of these scourges of gyri cum cretae, vel hydrargyri chlori- 
infantile life, and generally concede that di mitis. I wish to intercept right here 
among its most potent pathologic causes that the last named drugs are obsolete with 
may be named the period or season most me; I have banished them from my arm- 
likely to develop the conditions is the hot amentarium almost entirely, 
season of the year. Period with the child The prescription I allude to of the Medi- 
most likely to develop these troubles the cal World contains, as far as I can recall, 
period of dentition. That indigestion bismuth subnitrate, cretae praeprrara and 
plays its part in the causic drama goes sulphocarbolate of zinc, and powdered nut- 
without saying. meg in syrup of ginger. I do not at pres- 

But we all know that this condition ex- ent recall the quantities of the ingredients, 

ists, no matter what its cause is; and it is Several years ago I was led to change the 

our duty to meet the therapeutic and prescription on account of trouble the 

prophylactic conditions as best we may. syrup of ginger gave me. I found that 

It is of this I wish to say some things. syrups and elixirs in such medication in in- 

As the mothers who furnish the lacteal testinal derangement are objectionable 

secretion from their own mammae, they generally. Here is the way I write my 

should avoid anything in their own diet improved prescription: 

calculated to engender digestive disturb- ^ g.^^^^ subnitrate 3ij. 

ances in themselves; as this often eflFects '^ - r ' 

the part of her being, even after the period J^^ P Jj jj^^' 

of utero gestation has passed and during ^j^^^ hLam"eiis.V.V.." ." .' .' .' ?.5ii 

Ae period of lactation; and st.ll unt.l the ^^^^^ ^^^^^^ ^j^, 

period of dentition is completed to the ex- . ^u • ^ « «•;: 

tent that it furnishes a sufficient number ^^"^ "^^"*^- P^P ^•^- ^"J 

of teeth to masticate properly prepared M. Sig.— A teaspoon ful after each pas- 
food, at suitable periods; then under nor- sage from the bowels. I sometimes, if the 
mal conditions may the child be taken from indications point that way, increase the 
the maternal organ of nutritional supply, carbo ligni and add one or two drops of 

I have seen some mothers who would tinct. ipecac to four or five doses. I also 

masticate great boluses of food and feed make another prescription, which is gener- 

2x5 

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2l6 



THE MEDICAL SUMMARY 



ally demanded to hasten a successful term- 
ination : 

1^ Tinct. echinacea 5ij. 

Fid. ext. populis monelifera.. .5J. 

M. Sig. — Ten drops to infant three 
months old ; increase dosage for older ones. 
A child a year old can take half a teaspoon- 
ful every three hours during the day time. 

Never waken a child out of sleep to 
give medicine, unless, of course, there is a 
comatose condition. 

There is another old syrup I have dis- 
carded and prefer it compounded without 
syrup, and that is the syrup rhei comp. I 
prefer a compound mentioned in the 
American Dispensatory as syrup rhei et 
potass, composetus. Eliminate the sugar 
from the standard formula and you have it 
right. The digestive power of an intesti- 
nal canal in the cases I have under con- 
sideration here is already much impaired, 
and to require them to digest the syrup in 
conjunction with drugs prescribed for the- 
rapeutic purposes it often impairs the ef- 
fect of the drugs. This I conclude to be 
the case in the prescription I have men- 
tioned above. 

This may cause drugs to become toxic 
agents by chemical change, caused by the 
action of digestive juices. 

I wish to call attention to the fact that 
such cases should be given plenty of water, 
not in a large amount at any one time, but 
small quantities often repeated. If fever 
prevails in any case, sponging with warm 
water to w^hich has been added a small 
quantity of vinegar; this is an excellent 
antipyretic. I believe castor oil to be one 
of the purgatives, or Epsom salts, in broken 
doses. Aconite has an important function 
in many cases, used in small doses; re- 
peated for a few doses frequently until the 
temperature begins to decline* 

I wish to say as a matter of dietetic in- 
struction, the mother's milk is generally 
superior to anything else to nourish in- 
fants, and should be regulated, both in re- 
gard to quantity taken at a time, and time 
of taking. This being the important point 
to determine by the attendant in regard to 
dietary instructions. To children who use 
artificial nourishment the same rule applies, 
bearing prominently in mind that troubles 
of this kind require close watching. 



Older patients who eat ordinary food 
should be restricted in their diet, and I am 
sure it is better to adopt a milk diet, lim- 
ited in quantity, and administered often 
enough to prevent inanition. 

In numbers of cases I am sure that the 
judicious administration of Dr. Andrews* 
spiriticus frumenticus Americanus, vel 
spiritus Duffy will do, if there is not time 
to change the techneality in the nomencla- 
ture. 

W. M. Alter, M.D. 

England, Ark. 



POLIOMYELITIS AND BEDBUGS. 

Editor Medical Sumrmry: 

Information is requested regarding any 
correlation between insect bites and the on- 
set of poliomyelitis. Physicians are espe- 
cially requested to ascertain if the bed, 
chamber, dwelling, or summer camp occu- 
pied by case at time of onset is infected 
with bedbugs. Did patient have reason to 
believe he was exposed to bedbug bites in a 
public inn, amusement hall, sleeper, passen- 
ger boat, or elsewhere shortly before ill- 
ness Any data relating to bedbug bites 
and coincidental onset of infantile paraly- 
sis or other acute illness will be appreciated, 
tabulated, and published. 

Jacolyn V. V. Manning, M.D. 
Research. Not in Practice. 

151 Lafayette Ave., 
Brooklyn, New York. 

Medical exchanges please copy. 



SEVERAL MORE POINTS ABOUT THE 
MOON AND ITS INFLUENCES. 

Editor Medical Summary: 

In my communication which was hon- 
ored by publication in the July Summary, 
I very carelessly gave credit to Dr. 0. B. 
Surface for writing well on "Instrumental 
Delivery," when such credit should have 
been given to Dr. Charles Van Wye. 

You will remember that I have had some 
views regarding the moon as a valuable 
time keeper for doctors. 

There is a mistaken prejudice against 
the moon in connection with any such re- 
lation, and I desire to speak for our most 
useful luminary. 



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THE MEDICAL SUMMARY 



217 



1 contend thac her face can be utilized 
by us in certain particulars, as it is by the 
nigi.iiy manner to whom she "travels as a 
smnmg hand that marks off the houra vvita 
an accuracy no clock can ever rival." it 
ib uinized by the surveyor, by the courtnig 
coupie, and shall 1 again court prejudice 
by writing that it is utilized by the larmer, 
and by the old woman in connection with 
"worrunia, ' and spasms? 

But there is a relation in time between 
the phases ot the moon and menstruation — 
anu undoubtedly tne ancients well coined 
the word menses, monthly, or moonthly 
discharge. 

Women usually give birth at times 
which anticipate by a few days their men- 
strual dates, or the births may occur a few 
days after the usual date for menstruation. 
They seldom menstruate during the days 
of the full moon. 

In this statement I am amply substanti- 
ated by the celebrated Landois in his 
physiology. 

. ..^ v*..ies lor meiiitruatiun, and there- 
fore the times when labor may be ex- 
pected, are usually at the new moon, a 
very dark period, as if nature sought to 
hide the woman in her impurity, while she 
**pays tribute" to it, and when the moon 
hangs by its horns, in the shape of a small 
crescent, as at the time either before it is 
recorded as entering into its first, or sec- 
ond quarter. 

The moon would guide us in other con- 
nections, particularly the medical man 
among the nervous and insane, and this is 
no ancient fable, as usually supposed by 
modem conceit, or alleged knowledge. 

In conclusion, it is very useful to know 
that the best time during which to make a 
vaginal examination is at the time of the 
full moon, for then we may reasonably in- 
fer that the woman's ^'courses" are not* in 
process, the word "courses" again sug- 
gesting an etymological connection with 
lunar phenomena, the moon in her course. 
Thos. R. Evans, M.D. 
Prince, W. Va. 



For seat worms irrigate lower bowel 
with plain infusion of quassia daily for a 
week or two. Injection should be given 
through a long rectal tube passed beyond 
the sigmoid. 



ACNE. 

Lditor Medical Siiminary: 

It is a weil known axiom, in medicine 
that acne vulgaris is one of the mu^t fre- 
qaent diseases we are called upon to treat, 
and yet few of us rarely prescribe the 
proper medication, consequently obtain bad 
results. Primarily the disease is nearly 
always due to toxins circulating in the 
blood and following as a result of gastro- 
intestinal disturbances. Many authurities 
attribute the cause to a neurotic condition, 
or as a result of parasitic invasion ct the 
derma. 

Treatment. — I consider of paramount 
importance, proper regulation of tiie diet 
and systemic medication, and have always 
obtained excellent results.' If the diges- 
tive organs are at fault I prescribe : 

9 Acid hydrochloric dil., 

Tinct. nux vomica aajj- 

Fid. ext. cascara arom 5iiss. 

Aqua q.s. ad. Jvj. 

M. Sig. — Dram one t.i.d. after meals in 
a little water taken through a glass tube. 

Apply locally. 

hJL Alagne^ium sulph 5^'^U- 

M. Sig. — Put two tablespoon fuis in a 
pint of tepid water and use three times a 
day as a wash. 

Exercise in the open air, bathing and 
calisthenics are strongly advised. It is im- 
portant to eliminate from the diet such ar- 
ticles of foods as pastries, pickles, pork, 
excess of potatoes, excess of tea, cocoa, 
coffee, and alcoholic drinks. The frequent 
ingestion of cakes and ice cream should 
be interdicted, and the patient should not 
eat between meals, such articles as cheese, 
sandwiches and preserved fruits or vege- 
tables; sausage flavored with a large 
amount of pepper is bad, as well as the 
frequent use of condiments. Of paramount 
importance is the avoidance of irritating 
cosmetic soaps, frequently advertised to 
cure this condition. It is a mistake to ad- 
vise steaming of the face, the use of 
very hot water as a wash, expression of the 
pustules, cauterization, electricity and the 
like, as all these forms of treatment will 
result in ultimate harm instead of good. 

Tincture of green soap used with tepid 
water is the best form of local mechanical 



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cleansing I know of, and if used persist- 
ently the face will become clear, white 
and clean. It is a good antiseptic, re- 
moves excess of grease and is not so irri- 
tating as most soaps containing a large 
amount of potash. 

To reduce the toxicity of the blood I 
use: 

9 Sodium sulphate (saturated so- 
lution) Sviij- 

M. Sig. — One teaspoonful in a tum- 
bler of warm water on an empty stomach 
» every morning. 

As a soothing local application: 

5t Liq. calcis sulph Jviij. 

M. Sig. — Use two teaspoonsful in one 
ounce of water as a lotion twice a day. 
A. Charbonneau, M.D. 

Suite 606-607 Minahan Bldg., 
Greenbay, Wis. 



ANCIENT ARTERIAL DISEASE. 

Editor Medical Summary: 

Through the London Lancet we have 
been learning of Dr. Ruffer's studies of 
Egyptian mummies, with reference to ar- 
terial disease among them. The inference 
drawn is that these Egyptians lacked our 
commonly ascribed causes of arterio scler- 
osis ,and yet had the disease as much as we. 
Evidence from such a source bearing on 
such a subject seems to be far-fetched and 
uncertain. These Egyptians may not have 
used tobacco, but they probably were not 
free from the tendency and weakness that 
as far as we know has pertained to all hu- 
manity, and that would induce them to be 
addicted to the use of some other perni- 
cious weed or drug, equally liable to the 
indictment of tobacco; they may not have 
used alcohol to the "drunkard** extent, yet 
moderation means saturation, and as much 
or more danger; they may not have stuffed 
their stomachs as we do, but it is doubtful 
if they were all Fletcher izers, or nearly all 
abstemious eaters. 

It is also claimed that excessive muscu- 
lar exercise was not one of their faults. 
Then might not the lack of it be a cause? 
Many of these mummies might have lived 
old enough so that they ought to have had 
sclerosed arteries just from extreme senil- 
ity. Lastly, in my opinion, it is doubtful if 



with such subjects and pertaining to such 
a thing as the condition of arteries at time 
of death, there could be any but speculative 
evidence. So I feel that we need to keep 
right on hammering the old causes into the 
people until we actually know something 
different, since we can thus do nothing but 
good, but many do an infinite amoimt of 
harm by abandoning an old field for such 
evidence. 

A. P. Reed, M.D. 
Naples, Maine. 



"THE VERY BEST TONIC WE HAVE." 

Editor Medical Summary: 

"Doctors differ" is as true to-day as at 
any time. Dr. Gregory, in June Summary, 
comes to the front with the above caption, 
and I was glad he did, for some invaluable 
prescriptions were given, and I do not 
doubt the doctor's impressions and what he 
has found to be true in the past may hold 
good permanently, but if so it will be con- 
trary to the history of medicine — it is con- 
stantly undergoing a change. The writer 
is very familiar with the remedies the 
doctor uses in neurasthenia and also not a 
little acquainted with the disease. In 
reading his article I was reminded of a 
case I was requested to visit last winter— 
a young preacher who had overdone his 
brain power in preaching and rebuilding a 
fine church that had recently been de- 
stroyed. The writer was preceded by 1 
doctor who gave the young man, on gen- 
eral principles), a hypodermic of 1/40 
grain of strychnine, which came very near 
driving the "parson" to the insane asylum. 
The patient's condition was one of excita- 
tion, a condition that forbids the action of 
all stimulants. It is only reasonable to 
suppose that as ignatia is one of the 
strychnine family it, too, is not admissible 
in cases of excitation unless carefully 
guarded with anodynes. The main trouble 
with the young divine was that he could 
not sleep — had gone several days and 
nights with an hour's sleep; he was all 
p's and q's, every nerve tuned to a very 
high tension. The following gave rcliet 
A tablet composed of asafoetida, bismuth 
subnit. hyoscyamus, nux vomica and enough 



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THE MEDICAL SUMMARY 



219 



podophyllin — 1/20 grain — ^to "touch the 
liver," given just after eating. The pa- 
tient was ordered to cease all thought of 
preaching, building churches, or to listen 
to any preaching, praying, or long-drawn- 
out conversations, to take exercise in the 
open air, quit home except to eat and 
sleep. 

But going back to the tonic question : It 
is just out of all reason to claim that any 
remedy will meet the "thousand-and-one" 
pathological conditions. What we need in 
every case of debility more than all else 
is to place the digestive organs in a condi- 
tion that will call for an appropriate diet — 
we can't live on tonics ! Then, if we have 
a case presenting a condition of atony, 
broad, full, lazy condition of the whole sys- 
tem, muscles, glands, &c., as indicated by 
the tongue, can we expect to stimulate to 
action those organs by giving anodyne or 
quieting remedies? Or, if the condition is 
one of excitation, characterized by a 
pinched face, contracted tongue, &c., we 
need not expect to give relief by prescrib- 
ing remedies like ignatia, strychnine, &c., 
that will invariably bring about more ten- 
sion. 

I like to see a doctor claim all the good 
things he or some other M.D. has discov- 
ered, but I think, from long experience, 
that we scarcely know all medicinal prop- 
erties of the oldest remedy. The thing, as 
I see it, is to know from the expression of 
disease just when the remedy is specifically 
or specially needed and with a faultlessly 
made medicine give it with every assur- 
ance of success, so far as removing the 
abnormalities that indicate or call for that 
special remedy. A case in practice of 
erysipelas is to the point: A lady who 
had a lachrymal abscess, complained of a 
severe burning and discoloration of the 
abscess and neighboring tissue. It was 
readily diagnosed as erysipelas, and the 
old specific, tincture of iron, was promptly 
prescribed, but after a twenty-four-hour 
battle it was decided that the case was 
decidedly worse. Another consideration 
was in evidence, with the result of setting 
aside the name of the disease and a pre- 
scription that covered the special indica- 
tions was given, with rapid relief. This 
remedy was sulphite of soda — not sul- 
phate — and was given because the dirty 



white tongue called for that special remedy. 
When the sulphite of soda was prescribed 
the lady's best friend would not have 
recognized her, as her head and face were 
swollen to their greatest capacity, a very 
high range of temperature, severe pains 
and a semi-delirious condition of the brain. 
The sulphite of soda proved to be sedative, 
anodyne and every other needed medica- 
tion. 

This is plain sailing, but just why all 
doctors do not adopt this plan of reasoning 
but rather cling to empiricism and continue 
to prescribe remedies "that have been 
found to be good in treating a case," is 
quite past finding out. 

O. D. R. Kirk, M.D. 

Shuqualak, Miss. 



THE TREATMENT OF ASTHMA, 



Editor Medical Summary: 

In the treatment of asthma by definite 
medication the indications are simple and 
clinical, and fine distinctions must be made. 
These distinctions are calculated on anat- 
omical and physiological changes. The in- 
telligent prescriber will return to his long- 
neglected anatomy and physiology with an 
interest to know his fundamentals better. 

In the book. Definite Medication, there 
are 29 reading lines devoted to asthma. In 
these are given the characteristic clinical 
indications of five types of asthma defi- 
nitely treated by six remedies in combina- 
tion e. g. : 

"In asthma with emphysema, pale face, 
lips cyanotic, pulse small and soft, espe- 
cially in old people. 

^ Fid. ext. quebracho .^j. 

Simple syrup S^iij. 

M. Sig. — Take one teaspoon ful every 
three hours." 

Now, aspidosperma causes the blood to 
take up more oxygen and poisonous doses 
prevent the blood from parting with its 
oxygen to the tissues. It seems that in this 
form of asthma the blood does not part 
with its oxygen to the tissues. What 
should bring about this state of affairs but 
the retention of products of metabolism, 
which have a stronger attraction for the 
oxygen. This combination is broken up 
by small stimulant doses of quebracho. 



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THE MEDICAL SUMMARY 



iJrieriy, this is the physiological condi- 
tion. The anatomical interest lies in the 
fact that the skin, lungs and kidneys act to 
?- certain extent vicariously. The sweat 
glands are controlled by nerves. As a per- 
son past middle life ages the subcutaneous 
supports waste and the vessels and nerves 
are relaxed and become twisted and more 
exposed. They become sensitive to changes 
of temperature and humidity. A chill or 
series of chills and reactions cause the 
urates in the sweat glands and capillaries 
to become irritants to the vasomotor 
nerves and small vessels. A nerve ten- 
sion and contraction results. The sym- 
pathetic then distributes the elimination 
through lungs and kidneys. The urates 
are distributed to these organs to eliminate. 
The skin glands and vessels soon relax and 
the blood flows in great volume to the sur- 
face, leaving the lungs filled with toxic 
products which they attempt to eliminate 
by expiration and which prevents a free 
exchange between air and blood, of oxy- 
gen and CO2, until quebracho corrects the 
maladjustment. 

"When there is difficulty of breathing, 
with a feeling of constriction or weight in 
the chest, a sensation as though the blood 
was running to the chest, in such a condi- 
tion lobelia inflata is the remedy. Give 
ten drops of the third decimal dilution 
every hour." 

This kind of asthma is commonly met in 
persons of middle life, laborers or farmers, ' 
those who work in their shirt sleeves ex- 
posing their chests to evaporation, more 
than other parts. They stoop over at work, 
exercise violently with voluntary muscles, 
while the stomach and bowels are com- 
pressed, then completely relax the same, 
and in subsequently cooling off subject the 
ch^t, head, neck and arms to a local re- 
turn of waste, rather than a general re- 
tention as in the old person requiring 
quebracho. 

In this case notice how homeopathic is 
the prescription of lobelia 3X, while the 
prescription for quebracho, a true type of 
old school prescribing to obtain physiolog- 
ical action on rational grounds and scien- 
tific data. 

The prescription of lobelia follows the 
law of "Similia, similibus curantur:' Lo- 
belia in full doses causes speedy and se- 



vere vomiting, sweating and general re- 
laxation, ioxic doess cause burning pain 
in the fauces and esophagus and progressive 
failure of voluntary motion, rapid feeble 
pulse and fall of temperature, hy experi- 
ment it is found to paralyze the motor 
nerve trunks or peripheral vagi, and prob- 
ably also the vasomoter centers. 

Lobelia is thus definitely homeopathic. 
It causes muscular activity of the stomach, 
followed by relaxation and sweating and 
its action is more directly on the pneuino- 
gastric nerve which is affected by this 
form of asthma. 

'In asthma when the breath stops when 
the patient goes to sleep and wakes with a 
start, gasping for breath, there is a cough 
attended by tenacious mucus, tincture 
grindelia robusta is the remedy. Dose,, 
ten drops once in two hours." 

I am now treating a case with this form 
of asthma, a young man of 22 years. His 
asthma becomes hay fever each spring. I 
have given him the remedy indicated and 
the first night he was relieved. The im- 
provement continues under this treatment. 

In this form of asthma the condition is 
one of enervation, lowered vitality, low 
blood pressure with attempt of the blood 
to throw off its poisons in the form of ca- 
tarrh of mucus, because the vitality and 
pressure are not equal to the exertion of 
eliminating through glands and channels 
requiring higher blood pressure, e. g.^ 
skin, lungs and kidneys. 

Stimulation is the need here, and grin- 
delia in small doses stimulates the sensory 
nerve trunks, then motor cord. It stimu- 
lates the bronchial mucous membranes. This 
is an example of true eclecticism, raising 
the vitality and thus assisting nature to 
cure the disease. 

"In old people who are asthmatic and 
have to sit propped up in bed, dyspnea, 
great accumulations of mucus with much 
rattling and wheezing, give ' tincture 
senega. Put seven drops in a half glass of 
water and give a teaspoonful every hour 
till relieved." 

In such cases retention and enerz'ation 
are both present, and the syst^pi attempts 
to throw off the products of waste, as 
catarrhs, with feeble success. Senega as- 
sists by stimulating all the secretions, espe- 
cially those of the lungs. 



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*ln a severe attack of asthma when the 
patient was pressed for breathing and 
wheezing I gave tincture gelsemium and 
tincture sumbul of each eight drops in a 
tablespoonful of water once in fifteen min- 
utes until relieved. Many a time this 
remedy has helped me relieve an asthmatic 
patient." 

Such cases often result from reflex irri- 
tation of the vagus fibers of the stomach 
following indigestion or stomach retention, 
or atmospheric changes to which the sym- 
pathetic centers are peculiarly sensitive. 
Here the afferent nerve system is toned up 
by the sumbul, and the efferent cerebro- 
spinal reflex function is depressed. An- 
other refreshing example of fine rational 
therapy ! 

Now, doctor, I hope you will better ap- 
preciate our devotion to definite medication, 
because it is founded on definite anatomi- 
cal, physiological and scientific data and 
marks a definite, progressive step in treat- 
ing disease successfully. 

We have an "endless chain" of definite 
medication enthusiasts and I hope you will 
be one with us. You know one does not 
make friends in the driving hours of labor, 
but in leisure hours of comradeship. The 
secrets of nature are in the hearts and only 
kindness and good will, mutual understand- 
ing and benefit, will draw them out. Are 
they worth it? The correspondence re- 
quires time, but it pays. Make out your 
alphabetical list and send a friendly cir- 
cular from one to the next. Select a few 
enthusiasts and thus draw them close to 
you. Keep in touch with us and let me 
hear from you often. If you do not catch 
the idea of the "endless chain," I will be 
glad to make it clear. 

W. G. Jefferson, M.D. 

346 Cumberland Ave., 
Portland. Maine. 



The practitioner who fails to use tinc- 
ture of capsicum frequently neglects a val- 
uable remedy. It is a quick diffusible stim- 
ulant and one that can be used without fear 
of harm whenever such action is needed. 
Quickest results are obtained if given in hot 
water, with a nttle sugar. Dose from two 
to five drops, repeated every half-hour until 
the desired effect is produced. 



SOME "SUMBiARY." 

Editor Medical Summary: 

In many of your "Gleanings" you remind 
us of simple and effective therapeutic 
measures, which we have known, and have 
used with beneficial results. 

As to veratrum in the congestive stage 
of pneumonia, in plethoric subjects, I am 
in the habit of using it. It is bloodless 
bleeding measure; and aconite is valuable 
also, to a certain time. Digitalis must 
not be overlooked, either 1 In the resolu- 
tion stage, I give it, strychnine and nuriate 
of ammonia. If there is much pain I ad- 
minister codine. So much for that. 

You say, remove enlarged tonsils. I say 
no. They can be reduced to normal size 
by local treatment. They are not in the 
throat for ornamental purposes. There is 
too much throat surgery nowadays. 

You say, "never empty the distended 
bladder at one sitting." I have emptied a 
distended bladder many a time, with a 
"Nelation" catheter ; and have never known 
any reason why it shouldn't be emptied. 

You say, "Never use a brittle, or rough 
catheter." Who would? 

"Never open a prostatic abscess through 
the rectum." I know of two cases of such 
abscess which opened into the rectum 
without surgery, and no bad effects fol- 
lowed. Another, very recently, which dis- 
charged into the bladder, and the man 
was bad off for four weeks, necessitating 
regular lavage of the viscus. If it had 
opened into the rectum he would have re- 
covered in half the time, and escaped 
much discomfort. 

You ask, "What has become of the old- 
fashioned folks, who used to drink sassa- 
fras tea in the spring, to thin their blood?" 
They are here. 

Dr. Davis* "itch without an eruption" is 
here also. It seems to become almost in- 
tolerable as soon as the clothing is re- 
moved for retiring; and the greatest itch- 
ing is from the knees down. I have tried 
several applications, and am glad to know 
that balsam of Peru and vaseline will do 
the work. Ichthyol and quinine has done 
pretty well, as I am sure it is purely a neu- 
rosis. 

Dr. Smith, in "Clinical Medicine^" has a 
trnublesome remedy for epistaxis. I use a 



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222 



THE MEDICAL SUMMARY 



nasal syringe, rinse out the nostrils thor- 
oughly, and then inject with a mild solu- 
tion of persulphate of iron, and it ceases 
almost at once. If it doesn't cease, I in- 
crease the amount of MonseFs solution. 
Just had a bad case of epistaxis in a man 
TJ years old, and the first injection of 
Monsel's, one-third strength, stopped it im- 
mediately. Sometimes a solution of alum, 
salt, or tannin will answer; but if you 
want a "dead shot," use persulphite. 

A. L. Field, M.D. 
Jeflfersonville, Ind. 



MICROBES AND BACILLI. 

Editor Medical Summary: 

What fearful scarecrows they are ! I 
can remember away back, when we cured 
typhoid fever and pneumonia without a 
suspicion that we were beset with bugs as 
the cause of the disease, and in order to 
cure, we must destroy them! In looking 
back, I find the mortality from "bug** dis- 
eases was no greater than it is to-day. 
We treated the cases symtomatically. Ty- 
phoid cases were generally the gravest idio- 
pathic kind; with great exhaustion of the 
vital powers; subsultus; muttering deli- 
rium, and dry, cracked tongue. Strange to 
tell, I knew many such cases to recover. 
They would do no better now, with anti- 
septics and germ destroyers. We used 
turpentine internally and locally as stupes. 
Turpentine is a good "bug" killer, as are 
sulphocarbolates, salicylic, and carbolic 
acid. 

D. L. Field, M.D. 

Jeffersonville, Ind. 



"HONOR TO WHOM HONOR IS DUE.** 

Editor Medical Summary: 

In the July Summary, Dr. Thos. R. 
Evans gives me credit for an article in the 
April Summary, on "Instrumental Deliv- 
ery," which was written by Dr. Van Wye. 
I happened to have a report of "Early 
Menopause" on the same page, which is 
how the doctor got the names mixed. And 
I might add en passant that I agree heartily 
with Dr. Evans about using forceps all the 
time or in half of the cases that come to 
one. 



I have practiced obstetrics for nearly 
thirty-three years, and have used, and 
helped use, forceps five or six times, while 
I know several doctors who have not been 
in practice a dozen years who have used 
them fifty times or more; for two reasons, 
viz.: First, to make a larger bill, and sec- 
ond, to get away quicker. I know a young 
physician, who had the temerity to dis- 
close the secret to a friend, that he told 
the folks that it was necessary to use for- 
ceps, and then he would get twenty to 
twenty-five dollars for a case, where other- 
wise he would only get ten. Such robbers 
are a disgrace to the profession, but I am 
sorry to say they are the ones who make 
the money. 

O. B. Surface, M.D. 

1618 Shelby St., Indianapolis, Ind. 



HOW TO KEEP HYPODERMIC NEEDLES 
IN GOOD CONDITION. 

Editor Medical Summary: 

Up to some years ago, I had my share of 
trouble with hypodermic needles. Then 
I devised a method, which has give.i me so 
much satisfaction that I desire to pass it 
along as part payment to the profession 
for the many good things received by me. 
By tins method needles are almost inde- 
structable, are always aseptic, and the use 
of the pesky little wire, which never did do 
what was expected of it, is done away 
with. 

The method is this : Demand a cup of scald- 
ing hot water, and immediately after using 
the syringe, draw it full of the hot water, 
th-ough the needle of course, and squirt it 
out. Do this two or three times. Then 
wipe off the point of the needle with a bit 
of cotton, point the needle directly up- 
waid, and pull the piston out its full length. 
Leave the piston in this position until you 
unscrew the needle, and whether you use 
it next day or next month, you will find it 
in perfect condition. In ten years I have 
never had this plan fail me. The needle is 
put away clean, hot and dry, and therefore 
cannot corrode. Time consumed is about 
ten seconds. 

Charles G. Purdy, M.D. 

151 Linden Ave., Brooklyn, N.Y. 



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GASTRIC ULCER, CYSTITIS AND CHRONIC 
GASTRITIS. 



Editor Medical SummsLry: 

Here are a few favorite prescriptions 
that will open your eyes and do a lot of 
good for your patients. Try them, in 
cases indicated, and report the results: 

GASTRIC ULCER. 

I. Rest in bed. 2. Rectal feeding when 
case is severe. 3. Diet on peptonized milk, 
for a couple of weeks, then gradually add 
tgg albumin and beef juice. 

Internally give — 

5c Sodium bromide gr. x. 

Bismuth subnitrate gr. xx. 

Phenol .gr. %. 

M. Sig. — Ft. pulv. I. Mitte pulvis 
XXX. (One powder three times a day with 
a little peptonized milk. 

CYSTITIS. 

J)L Hexaniethylinamine 5iij. 

Potassium acetate 5iv. 

Fid. ext. buchu 5*ss. 

Tinct. belladonna 5iij. 

Tinct. hyoscyaraus Jss 

Infusion triticum repens. . .^xvj. 
M. Sig. — A tablespoonful every three 
hours, in one-half glass of water. 

CHRONIC GASTRITIS, ASSOCIATED WITH 
NERVOUS HEADACHE. 

9 Fid. ext. cascara arom 5iij. 

Fid. ext. hydrastis 5v. 

Strychnine sulph gr. ss. 

Fid. ext. guarana 5u- 

Elixir pepsin lact 5u- 

Aqua q.s. ad. Jviij 

M. Sig. — A teaspoonful three times a 
day, one hour after meals. 

A. Charbonneau, M.D. 
Suite 606-607 Manahan Bldg., 
Greenbay, Wis. 



RECTAL FEEDING. 

Editor Medical Summary: 

Soups and broths are nothing but salt 
water with an odor of osmazome. 

In a case of an old woman seventy- four 
years old, suffering from cerebral hemor- 
rhage. She was kept alive by rectal feed- 
ing of raw milk. We are taught that di- 
gestion ceases in the colon. All the same 
the milk was digested and the stools were 
alvine and not composed of milk or curds. 
This milk would be fine as a Murphy drip. 
R. D. Fairex, M.D. 

1825 Fourth St., New Orleans, La. 



CANCER. 



The August number of the Cosmopolitan 
contains an article on cancer, written by 
Peter Clark Macfarlane, in which the eti- 
ology and pathology of this widespread and 
ever-increasing disease is presented in such 
style as the layman can grasp. The writer 
points out that cancer is not really an 
"eating" disease, but rather one of cellu- 
lar break-down or perversion; that cancer 
cells are no more than good cells gone 
wrong. "In a crude and general way," 
says the writer, "cancers may be divided 
into three classes: those attacking the lin- 
ing surfaces of the body (as the skin or 
stomach), those that thrive in the body tis- 
sues, and those that attack the bones." 
Serotherapy and chemotherapy are dis- 
cussed, as well as X-ray treatment; but 
after all, in the light of our present knowl- 
edge on the subject, extirpation by the 
knife is emphasized by the writer as prom- 
ising the most favorable results. 



Tinnitus may be due to turbinal press- 
ure in t^^ nose, but is generally of tymp- 
anic origin. 



273 



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Hiccough can be cured by traction on 
the tongue. 

Rheumatism may attack the palate, and 
is particularly painful. 

In attacks of dizziness look for involve- 
ment of middle ear. 

Through the crico-thyroid membrane is 
the best place for an urgent tracheotomy. 

The nicest way to give mercury to chil- 
dren is in the form of mercury with chalk. 

Enlarged tonsils frequently shrink 
when adenoids are removed. 

In all cases of croup give antitoxin. It 
never does any harm and often cures in 
twenty-four hours. 

In chronic laryngitis in singers spray 
with 2% solution lactic acid eight or ten 
times daily. 

After removing tonsils dusting with or- 
thoform allows solid food to be swallowed 
without pain. 

A great many cases of hemorrhoids will 
be cured by forcible dilatation of the rec- 
tum under local anesthetic. 

Iodide of arsenic is a valuable remedy 
when scabs form in the nostrils, and there 
is rawness and sensitiveness of the parts. 

Inspissated cerumen should never be 
curetted from ears but washed out with 
warm water with a large hand syringe and 
must be entirely removed at one sitting. 

Iodide of arsenic is useful either in 
chronic or acute catarrh, where the nasal 
passages and frontal sinuses are inflam- 
ed and in a state of ulceration. 

The dangers from hypodermic injections 
are: Xeedle abscess, injecting the medica- 
tion into a vein, (tendency to the forma- 
tion of drug habits, introduction of air 
into a vein, breaking of the needle, and 
hypermedication. 



If you kiss the baby because he is "such 
an angel" you may make him one. 

When patient complains of a feeling of 
a foreign body in the throat look for en- 
larged or inflamed lingual tonsil. 

Pushing the jaw forward or traction on 
the tongue will stop the paroxysms of 
whooping cough. 

Where there is any doubt of diphtheria 
give antitoxin and make your diagnosis 
on the result. Waiting for laboratory 
diagnosis may cost the child's life. 

The dose of drugs is modified by age, 
weight, sex, pregnancy, temperament, idio- 
syncracy, habits, time of day, climate, and 
the condition of the alimentary canal. 

In giving medicines do not be guided 
entirely by the text-books. The object in 
giving medicine is to get the eflFect and 
that is the main object to be kept in view. 

For round worms give child (six years) 
a glass of milk only for supper. Then on 
retiring give half grain each of calomel 
and santonin for three nights. 

Cow's milk for calves, mother's milk for 
babies. God pity the baby who cannot get 
mother's milk ! Out of every loo babies 
in the United States, 25 die each year. 
You wouldn't take a crowbar to adjust the 
delicate mechanism of a watch? Then why 
use drastic and dangerous drugs to adjust 
the delicate internal mechanism of a baby? 

Milk stations are cheaper than hospitals, 
and will save the lives of more babies. 
Why not but the baby before the window 
in the best room in the house and, if nec- 
essary, put the geraniums in the closed and 
darkened room. If sunlight and air are 
good for flowers, why not good for babies? 

Throw soothing syrup to the fishes. As 
Dr. Holmes said, "It may be hard on the 
fishes," but it at least will save the baby 
from harm. — Bulletin Indiana State Board 
of Health. 



324 



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A MoDtbly Journal ci 

Practical Medicine. New Preparations. Etc. 

R. H. ANDREWS. M.D., Editor and Publbher. 2321 P«fk Ave.. PhflA.. Pa. 
One Dollar Per Aanum in Advance. Sia^le Copies, 10 Cents 



VoLXXXlV. 



Phaaddphia. October. 1QI2. 



Na 6 



BUBSCSIPTION BATES: $1.00 per year, in ad- 
vance, to any part of the United States and 
Mexico. To Foreign Countries and Canada, $1.25. 

NEW SUBSCBIPTIONS may begin at any time dur- 
ing the year. 

HOW TO SEMIT: A safe way to remit is by postal 
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after the time paid for has expired, please notify 
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"THE MEDICAL SUMMABY/' 
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Entered at Phila. Post Ofiice as second-class matter. 



ABOUT FEES. 

This topic is always in season. The fee 
is our life blood. Two thoughts in this con- 
nection always confront us: How much 
shall I charge? How shall I proceed to 
collect ? It is a very difficult matter for the 
general practitioner to get his fees on a 
cash basis, because the doctor must neces- 
sarily deal with many who are indigent or 
who do not provide for the proverbial rainy 
day. 



Every doctor should encourage cash col- 
lections; or, next best, short credits. As 
an encouragement to pay cash many phy- 
sycians find it a good rule to make a special 
rate to those who pay promptly. If physi- 
cians practiced amidst ideal conditions the 
code of ethics would be of much service and 
inspiration in fixing fees. As matters ex- 
ist, however, there can be formulated no 
fee-scale that can be consistently and con- 
scientiously lived up to. 

The fee should be neither too large nor 
too small; it should be just right, or as 
nearly so as circumstances in the case will 
admit. It is an unwritten and inexorable 
law that people must be charged according 
to their ability to pay. This must be done 
in fairness to all peisons concerned. The 
well-to-do should not, as a sort of penalty 
for having economized and prospered, be 
victims of a medical hold-up. Our whole 
clientele should be educated to know that 
medical service is of equal value to rich and 
poor, with a certain leniency toward the 
latter when coming across with cash. 

It is a tolerably good rule to make the fee 
of a poor person the same as that of one 
who is well-to-do, with the understanding 
that if the former should unexpectedly pros- 
per he would be expected to play a square 
game with his doctor. If his ship does not 
come in, the difference between a fair and 
trivial fee is a debt of gratitude in the doc- 
tor's favor. 



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THE MEDICAL SUMMARY 



A CHECK ON DEGENERACY. 



The country is fast awakening to the 
fact that the stream of degenerate and un- 
fit humanity should be curbed. It is com- 
menrable and well that we care properly 
for undesirables already here, but i. should 
be our earnest, altruistic aim to lessen the 
output. Many persons should have charity 
exerted in their behalf before they are 
born. The States of Indiana, Oregon, 
California, Connecticut, Utah, Iowa, New 
Jersey and New York have passed laws 
legalizing the sterilization of hopeless luna- 
tics and incurables. The matter will be 
presented to the Legistatures of Florida 
and Louisiana this winter, as well as per- 
haps in a number of other States. In 
Texas no action has been taken, but Dr. 
Daniels of the Journal, has been working 
valiantly for years to get the subject before 
the Legislature and doubtless action will 
be taken soon. 



excruciating pains at the termination of 
the delivery. 



CHLOROFORM IN OBSTETRICS. 

It is the concensus of opinion of success- 
ful obstetricians that chloroform at some 
stage of labor is quite generally servicea- 
ble. The writer of this editorial finds it of 
value in at least nine out of ten cases. The 
tenth case may not be benefitted, but it has 
not as a rule proved any handicap. Once 
in a great while chloroform seems to cause 
the uterus to sink into a state of passivity 
and really retard the progress of the labor. 
As a rule, however, this quiescent state is 
conservative, and after a few hours of rest 
the labor goes on with renewed vigor. 

Chloroform should not be used too early 
in the game. We find it of most value in 
relaxing the rigid os and other soft tissues. 
Here it seems to make the pains stronger 
and more effective. It nerves the woman 
up and takes the keener edge from the 
pains, thus enabling her to "help herself." 
It should be the aim to secure only anal- 
gesic effects from the chloroform. During 
the passage of the head through the lower 
strait the anesthetic does not aid the ex- 
pulsory efforts of the uterus and abdomi- 
nal muscles. It may do good, nevertheless, 
by mitigating the suffering and thus giv- 
ing the woman courage. Chloroform 
should be pushed more freely during the 



ON TEACHING SEX HYGIENE. 

This subject has been pretty well 
threshed over the last year or so in both 
lay and medical literature. It is the con- 
sensus of all thinking individuals that sex 
hygiene should be taught the young more 
generally than it has been in the past, but 
the time, place and manner of teaching it 
have been rocks on which opinions have di- 
vided. Physicians, ministers, teachers and 
educated people in general have been heard 
from on this matter, but very little from 
the person most vitally concerned in the 
child's welfare — the mother herself. The 
whole subject is dealt with very conserva- 
tively in September Good Housekeeping by 
an anonymous writer purporting to be a 
mother. 

*The school is not the place for teach- 
ing sex hygiene," this writer asseverates 
in the closing paragraphs of the article in 
question, "but the Mothers' Club would be 
the place. Only, do come before the 
mother in a practical way. The scientist 
is so seldom a good lecturer or teacher for 
the average, non-scientific audience. I 
have talked with some of the mothers who 
have attended lectures of this nature. They 
came away horrified, disgusted, but not 
practically impressed; nor did they seem to 
have received the idea that the matter has 
any connection between them or their duty. 
To give such a talk to the mothers in the 
same way as it would be given to a body 
of medical students is a waste of time. 
To present the fact is one thing, to deduce 
instruction and moral guidance is another. 
Moreover, some mothers will need to be 
told not merely what to do but how to 
do it. 

"Help the mother to understand that the 
matter is not merely a subject to be sud- 
denly discussed at puberity, but. that it 
must gradually be instilled from the first 
moment that the baby becomes conscious 
of and curious about his little body; that 
the knowledge should not be given all at 
once, but bit by bit as the child develops; 
that sexual morality is the base of aW 
wholesome life and can not be suddenly 
produced at any certain period, but is 



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227 



gradually developed through the emotions, 
the spirit and the will. 

"Let the mother understand the exhuber- 
ance of young manhood, and that physical 
labor and athletics are better than *purity' 
books. Indeed, some of these so-called 
purity books, especially those that take the 
most awful instances of depravity from 
medical and legal records and put them in 
the form of a romance, are eminently un- 
fit to be read by young or old. 

"It would be difficult to find in the 
world's literature anything more salacious 
than certain novels put forth — alas that 
one should have to say it! — by a woman. 
A well-meaning woman, no doubt, but 
fearfully misguided. It would be impossi- 
ble, in an article like this, even to outline 
the plot of one of these in particular, so 
vile and revolting is it; yet this is 
'purity' literature, indorsed by a certain 
woman's organization and by 'reformers,' 
for circulation among young people. 

"In dealing with this subject one must 
be simple, one must be wholesome, one 
must be true. Any abnormal view of the 
matter is bad. There is another class of 
theorists who would make of our girls 
prudes and Puritans, and that is almost 
equally bad for the race. 

"I have given especial consideration to 
the young girl, because she will be most 
disastrously affected by any mistake in the 
matter. And never in the history of our 
country have our young girls stood in 
need of such careful protection and guid- 
ance as now." 



THE CRUSADE AGAINST SOFT DRINKS. 



The well known Dr. Wiley, now asso- 
ciate editor of Good Housekeeping, in the 
September number of that publication dis- 
cusses at length the matter of soft drinks, 
especially those which have been under 
governmental surveillance for some time 
because they were supposed to contain in- 
gredients deleterious or habit-forming. In 
the government investigation of the most 
extensively-advertised drink of this charac- 
ter the fact was brought out that chemical 
analysis did not show it to contain cocaine, 
but the objectionable element was caffeine. 
Caffeine, by the way, is presumed to be 
an added element in nearly all of the so- 



called soft drinks. The objections to 
cocaine are that it is a heart stimulant and 
makes the nervo-vascular system work 
overtime ; it makes the young and suscepti- 
ble nervous and may engender a pernicious 
habit. The quantity of caffeine contained 
in a single drink is perhaps inconsequential, 
but the habit for these drinks is so insidi- 
ous that before the user is scarcely aware 
of the fact he may be taking a dozen or 
twenty drinks a day. The natural thirst 
for pure, cold water becomes blunted and 
the victim is prone to satisfy his desire for 
fluids by these adventitious aids. 

In speaking of the deleterious effects of 
this stimulant, caffeine, we quote Dr. 
Wiley as follows: "Stimulation means in- 
creased exertion; otherwise it is of no 
value and wastes itself without helpful re- 
sults. All increased energy implies in- 
creased consumption of tissue and fuel. 
Fatigue is nature's danger signal to show 
that muscles, nerves, brain, etc., need rest 
and recreation. Any drug that strikes 
down the danger signal without removing 
the danger must of necessity be a threat. 
The thing to do when one is tired is to rest, 
sleep, and to take real food. The thing not 
to do is to take a drug that makes one for- 
get that he is tired. The thing most of all 
not to do is to offer that drug under a 
false and misleading name, at inopportune 
times, and for the sole purpose of gain." 

Neurasthenia, nerve depletion and drug 
habitues number more than 500,000, while 
the number who partake in some degree of 
alcoholics is almost beyond our ken. It is 
probable that many young children get 
their first impression of narcotic or stimu- 
lant drugs in so-called soft drinks, and this 
latter grows into a penchant for dope or 
alcohol. Parents should endeavor to incul- 
cate into the minds of children healthy 
drinking habits. Even those drinks which 
contain nothing more baneful than syrup 
and an admixture of gas may somewhat 
prevent the stomach secretions, at the same 
time creating an abnormal and unnatural 
thirst which may later require something 
stronger to appease it. 



Convulsions in children may be due to 
phimosis, adherent prepuce, an approach- 
ing tooth, adenoids, foreign bodies in nose 
or ear or the onset of an acute disease. 



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THE MEDICAL SUMMARY 



OUR ADVERTISING POLICY. 

We do not solicit or accept advertising 
matter that bears the earmarks of dishon- 
esty and fraudulency. Almost without ex- 
ception the advertisers who have presented 
their goods to the profession through the 
Summary year after year have been on the 
square and have exploited honest, meri- 
torious goods. 

It is our rule to accept only advertise- 
ments of goods that are presented to the 
profession and in the usual ethical channels 
of trade. Malted milk and prepared foods, 
cosmetics, rubber goods, etc., do not come 
under as rigid ethical scrutiny as remedial 
agencies designed to have definite thera- 
peutic action. 

We regard food preparations, soaps, syr- 
inges, etc., simply as commercial articles 
like buggies and automobiles. With reme- 
dies it is different. But the bid for patron- 
age of the latter must be made to and 
through the doctor. 

The Summary is and has ever been an 
ethical journal, conservative, "with charity 
for all and malice toward none." That will 
continue to be our policy and aim. We give 
readers and advertisers alike a "square 
deal." 

We shall ever exercise a conscientious 
censorship over our advertisers and will en- 
deavor to exclude anything that savors of 
the fraudulent or unreliable. We shall, 
however, accept as usual, advertisements of 
honest proprietary articles that have gained 
the approval of the very acme of censors, 
the general practitioner. 



CROTON OIL. 



Oleum tiglii, more commonly known as 
croton oil, is such a powerful drastic ca- 
thartic that it is seldom indicated as an in- 
ternal remedy. It is absorbed into the 
blood and produces glandular hyperemia, 
together with vigorous peristalsis. In the 
absence of obstructive conditions of the 
bowels and asthenic states croton oil may 
be employed sometimes to produce rapid 
hydragogue catharsis. It is contraindicated 
v/here there is debility, organic obstruction 
and inflammatory conditions of the stom- 
ach and bowels. The dose in pill or tablet 



is from one-third to two minims. It is 
best given in nimim doses and repeated as 
necessary until results are obtained. It 
acts in an hour or so producing copious 
watery stools. Externally croton oil is a 
valuable counterirritant in bronchitis, ovar- 
itis, pleurisy and neuralgia, but it has the 
disadvantage of sometimes leaving a 
cicatrix. 



BOIL IT DOWN. 



We desire to remind our friends that the 
pages of the Summary are limited, and 
that while we wish you all to write, wc 
must necessarily ask you to condense as 
much as possible, not to the detriment of 
clearness and the necessary explanation of 
facts, but by avoiding all unnecessary de- 
tail. 

A good rule for writers as well as house- 
wives to follow would seem to be: "Save 
the Scraps!" 

Is not the advise of the experts, how- 
ever, epitomized in Joe Lincoln's poem 
appended to the volume, which is entitled, 
"Boil it Down." 

If you have a thought that's happy, 
Make it short and crisp and snappy; 
When your brain its coin has minted, 
Down the page your pen has sprinted 
If you want your effort printed, 
Boil it down ! 

Take out every surplus letter — 
Fewer syllables the better — 
Make your meaning plain — express it 
So we'll know, not merely guess it; 
Then, my friend, ere you address it, 
' Boil it down ! 

Boil out all the extra trimmings- 
Skim it well, then skim the skimmings— 
When you're sure 'twould be a sin to 
Cut another sentence in two, 
Send it on. and we'll begin to 
Boil it down ! 



The first crop of oysters put on the mar- 
ket in the early fall is more likely to be 
contaminated by typhoid and other germs 
than those appearing later. If there is 
any doubt about the wholesome source of 
the bivalve it would be safer not to eat 
them raw. 



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^B iirf Mcl^pttctiolanicfct, thort and pithy wpoctt of mtefmiiig cmm in pradiee. new melhocfa and new reowcfie* aa 
»p pi ca b te mthaliie«tnientrtditea«e«. are aoKdled from the p r >4* » *« ^<«tf"«<*^^ q Aiticfca eootnbaled f or the 

Saounanrmusthecontribaaedtoitexdinivciy. CWnle plainly and oo one ode of the paper. 



The Editor is not rapooaUe for the 



THE REPAIR OF WOUIfDS. 

By Wm. Brady, M.D. 

The general management of wounds 
should be based on a practical knowledge 
of the physiology and pathology of repair. 
With a thorough understanding of the pro- 
cess of healing the young tyro may bring 
aLout the cure of old varicose or other 
ulcers which his senior colleagues have per- 
hrns pronounced incurable after years of 
empirical tinkering with various highly 
recommended ointments. Without going 
into details, a brief consideration of certain 
features of the healing process may be of 
interest. 

In a wound not aseptic, inflamatory 
symptoms are apt to appear on the second 
day. Every case should therefore be seen 
at this time, whether the dressing is to be 
disturbed or not. It is often wise to leave 
a strand of silkworm or gauze in the lower 
angle of an accidental wound of whose 
asepsis there is much doubt, and to remove 
it on the second or third day if the wound 
is clean. The best dressing for such a case 
is the wet normal salt gauze, which is un- 
deniably superior to dry gauze or ointments 
as a medium of drainage for exuding 
scrum. 

Sutures, if inserted, should be removed 
on the fifth day if there is no tension upon 
the edges of the wound. If tension is un- 
avoidable, the sutures should remain until 
about the tenth day. It is generally well to 
reinforce, or even replace suturing by ad- 
hesive strapping to relieve undue tension. 
A wounded extremity is always more at 
rest in a flexed position if such position 
does not cause gaping of the wound. Every 
wound of suflScient importance to require 
sutures is also of sufficient importance to 
require absolute rest, best attained by 
means of suitable splints, or firm bandages. 

The floor of a- deep laceration, as of the 



perineum, becomes covered after several 
hours with a varnish-like glazing of co- 
agulated fibrin from the exuded serum. 
Suturing at this stage will g^ve first in- 
tention union oft times even better than 
primary suturing. 

If not closed, an open glazed wound be- 
comes covered in two or three days with a 
dirty grayish membrane, which separates 
after a few days and is discharged with the 
pus, leaving a base of bright red granula- 
tion tissue. Granulatioa tissue is the vas- 
cular framework upon which cicatricial tis- 
sue grows. When it reaches the level of 
the skin a transparent, delicate film ap- 
pears around the edges and extends gradu- 
ally out toward the center of the granulat- 
ing surface, like ice freezing over a pond. 
This film is, of course, new epithelium, 
though I have seen nurses and doctors 
carefully wiping it away with wet gauze or 
cotton in the blissful notion that it was 
foreign material. 

New epithelial cells are as readily de- 
stroyed by chemical antiseptics as are pyo- 
genic bacteria. There is not only no ex- 
cuse for washing a healing wound with 
germicides, but positively a contraindica- 
tion to such maltreatment. Asepsis, not 
antisepsis, is the goal to strive for. 

Granulation tissue in large wounds or 
ulcers aids repair also by contracting and 
drawing the edges closer together. This 
gives us a valuable hint for the use of ad- 
hesive plaster about large granulating sur- 
faces. As to strapping directly upon the 
granulations, I have had only unpleasant 
results personally. 

A wound whose edges are not approxi- 
mated may still heal without suppuration if 
it be filled with aseptic blood clot, and kept 
aseptic — that is, left alone. Clean clot is 
an excellent culture medium for embry- 
onic epithelial cells. As healing progresses, 
a portion of the unabsorbed clot is pushed 
out by the granulating tissue and dries in a 



22Q 



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230 



THE MEDICAL SUMMARY 



scab which protects the surface of the 
wound. Aseptic clot repair occurs typi- 
cally in simple fractures, subcutaneous 
tenotomies, internal rupture of organs and 
healing of bone cavities following the radi- 
cal operation on sequestra. It is Nature's 
peerless method, and one that we should 
endeavor to imitate whenever the condi- 
tions permit. No other packing is as good 
as clean blood clot. No other wash is as 
good as blood serum. 

Given a recent wound of accidental na- 
ture, how shall we render it aseptic? In 
ordinary cases one thorough cauterization 
with iodine is usually sufficient, all subse- 
quent dressings to be without antiseptics of 
any kind. In wounds which give rise to 
the fear of tetanus or rabies, however, pure 
pnenol is preferable. If the wound has a 
cavity the phenol should be poured in after 
moistening the surrounding skin with alco- 
hol, and allowed to remain one minute. 
It may then be removed with a dropper and 
alcohol applied. If it is a puncture wound, 
the phenol must be applied on a cotton- 
wrapped probe, opening the track of the 
puncture if necessary to permit access to 
the farthest point. If it be a freely-bleed- 
ing wound, and still bleeding, I believe 
cauterizing is unnecessary under any con- 
ditions whatever. 

Many authorities are now reporting 
happy results from leaving granulating 
wounds and ulcers freely exposed to the 
air, under a wire netting for protection 
against insects or injury. Some writers 
report excellent results from treating skin 
grafts in this manner. 

Brewer's yeast is a remedy I have found 
very useful for hastening the separation 
of old sloughs and stimulating granulations. 
It smarts a trifle, but patients do not object 
to it, especially when they find they can 
obtain it for the asking. I have also given 
it in doses of one to two ounces internally, 
though with doubtful effects. 

For painful wounds and ulcers generally 
a simple dressing kept wet with warm 
normal saline solution seems most useful. 
The patient appreciates it better if he is 
given normal salt tablets (which, by the 
way, make real imitation plasma), rather 
than being directed to dump a teaspoonful 
of common salt into a dish of water. 

For ugly, painful old varicose ulcers a 



boon to the new doctor on the case is ortho- 
form, applied either as a dustin:^ powder 
or in 5% ointmen^. Some patients will de- 
velop erythema from orthoform, much 
like those formerly common when iodo- 
form was in use. 

For exhuberant granulations — "prouJ 
flesh," as patients seem to call it — I like the 
scissors. It can usually be trimmed off 
without discomfort. If this is not peniiis- 
sible, then firm pressure is the next method 
of choice. My experience with silver ni- 
trate has been uniformly uiisatia factory. 
So far as I can see, silver nitrate merely 
musses up the field of operations and stimu- 
lates the granulations to renewed activity. 
The clean, prompt, effectual way to re- 
move proud flesh is to cut it down. 

Carbolic acid, in any other role than as a 
cauterant is to be mentioned only to be con- 
demned. There is nothing known to do- 
mestic surgery that will delay healing of a 
simple wound like carbolic salve, unless it 
be a fresh and reeking poultice of gen«;ine 
cow dung. Antiseptics, other than cau- 
terants or recognized disinfectants, might 
well be discarded from the office altogether. 
We have little use for them. Once hav- 
ing asepticized a wound, I am sure tlie 
best policy from that point on is to avoid 
antiseptics and depend whollv upon simple 
cleanliness, with due regard to the all-im- 
portant consideration of the patient's op- 
sonic immunity and general condition. 
Vaccine therapy and internal medication 
are chapters by themselves. Our chief duty 
is to stand by fully armed while Nature 
does the work. 

In dry old varicose ulcers, carbuncles 
with little fluid drainage, and indurated 
swellings of various kinds in which in- 
cision is not productive of the usual benefit, 
the engorgement and coagulation of lymph 
in the vessels about the lesion is probably 
preventing free access of fresh opsonins 
or anti-bodies to the site of infection. 
Wright and others report good results in 
such cases from the use of citric acid in- 
ternally in 60 grain doses every three hours 
until a freer exudation of serum is ob- 
tained from the wound. The local use of 
citrate of sodium and salt solution is also 
advised — i/io of 1% citric acid and 4% so- 
dium chloride wet dressings. One case of 



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THE MEDICAL SUMMARY 



231 



Ludwig's angina reported by Sir Almroth 
Wright seemed hopeless despite free verti- 
cal incisions in the neck and a measured 
opsonic index of 1.8, there being serious 
physical prostration and insufficient exu- 
dation from the incisions to enable Wright 
to "fill a platinum loop" for culture. Yet 
two or three doses of citric acid, as men- 
tioned above, resulted in free oozing from 
the incisions and immediate institution of 
convalescence. As Wright says, it was not 
the patient*s lack of resisting power, not 
his need of vaccine treatment (as shown by 
the opsonic index), but merely the choking 
of the lymph vessels about the induration 
which prevented his ample supply of anti- 
bactericidal bodies from reaching the 
streptococci in the wound or lesion. 
1008 Lake Street, 

Elmira, New York. 



THE THERAPEUTIC VALUE OP BAPTISIN 
AND HAMAMELIN. 



By H. Hamilton Redfield, A.B., M.D. 

Professor of Therapeutics in the Bennett Medical 
College. Medical Department of The Lyola Uni- 
versity. Chicago. 111. Chief Therapeutist 
to The Jefferson Park Hos- 
pital, Chicago 111. 



Ellingwood states that baptisin is a glu- 
coside derived from baptisa tincturia (com- 
mon name, wild indigo), a plant belonging 
to the natural order of leguminosae, indi- 
genous to the United States. Dose of the 
standard granule 1/12 grain. 

Physiological Action, — Baptisin is a pur- 
gative, alterative and hepatic stimulant. 
Changes occur in the blood both of a qual- 
itative and quantitative nature. The ex- 
cretions have an offensive odor. The puls^ 
is soft, compressible and quick. Fetor of 
the breath exists. There is a tendency to 
decomposition of the body fluids. 

Therapeutics. — Echinacea and baptisin 
so closely resemble each other as regards 
their power over septic conditions that by 
some authorities it has been said that their 
exhibition is merely a matter of personal 
preference with the physician, as the indi- 
cations for one are the indications for the 
other, and they have been dubbed the 



Siamese Twins of therapeutics. However, 
a close study of these two most valuable 
therapeutic agents will show a marked dis- 
similarity in some very important respects. 
Baptisin is the indicated remedy in all 
cases where there is great prostration, 
with a growing tendency to a process of 
decomposition in the fluids of the body, 
and to ulcerations of the mucous mem- 
branes. Also in septic conditions or in 
diseases when the entire muscular struct- 
ure of the body feels sore and bruised and 
the debility and prostration are extreme. 

Baptisin should be remembered in head- 
ache that is dull and stupefying, with a 
confusion or. unsettled mental condition. 

In diphtheria, when the fauces are red 
and swollen, with the membranes of the 
color of washed leather. Here the ton- 
sils and lymph-glands of the neck are 
swollen and enlarged, and the breath is 
heavy and offensive. The fever in these 
cases is of a low adynamic type and the 
patient is restless and complains of a feel- 
ing of soreness about the head and limbs. 
Nothing can be swallowed but liquids. 

This drug has given good results in 
folhcular tonsillitis prior to suppuration; 
and in these cases it should be studied in 
connection with calx sulphurata and phyto- 
laccin. 

Dysentery occurring in old persons and 
diarrhea of children, with scanty blood and 
mucus stools and severe tenesmus, accom- 
panied by fever of a low type, show a 
marked change under baptisin. 

In cervical adenitis following attacks of 
scarlet fever or measles, baptisin in alter- 
nation with phytolaccin has proved its 
worth many times. Compare its action 
with that of phytolaccin and of iridin. 

Hamamelin. — From hamamelis virginica. 
Common name, witch-hazel. 

Indicated whenever venous congestion 
occurs, hamamelin should be studied. In 
cases of passive venous hemorrhage, vari- 
cose veins or hemorrhoids, when there is a 
feeling of soreness in the parts just as 
though they had been bruised. In all vari- 
cose conditions in any part of the body 
which are attended by a feeling of sore- 
ness which is intense in nature. 

It gives good results in varicose veins in 
the legs, when applied locally or given in- 
ternally. 



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THE MEDICAL SUMMARY 



In varicose veins of the throat, with the 
vessels much distended and the membranes 
of a bluish color. Great pain is experi- 
enced upon swallowing, and the parts are 
quite sore and painful with a hawking ex- 
pulsion of mucus and blood. 

In hemorrhoidal cases, when the pa- 
tient says he feels as though his back 
would break on account of the heavy, 
<lragging sensation, then soreness and 
burning in the parts, and the hemorrhoids 
bleed profusely. There may be a constant 
urging as though for stool, and a sore, 
bruised feeling in the anus. The hemor- 
rhoids protrude as a rule and are the color 
of grapes. 

In passive venous hemorrhage, seen in 
lacerated and contused wounds, where the 
flow is due to a condition of the blood- 
vessels, and not to any alteration in the 
chemical composition of the blood which 
would retard coagulation, hamamelin gives 
prompt relief, not only checking the hem- 
orrhage, but removing the pain and sore- 
ness in the vicinity of the wound. 

In epistaxis, when the flow is persistent, 
and is produced either by traumatism or is 
vicarious, hamamelin should be remem- 
bered. 

Hamamelin is an excellent remedy in 
those cases where the patient takes cold 
easily, especially if exposed to a warm, 
moist or relaxing atmosphere. 

Applied locally, hamamelin gives relief 
in phlebitis. 

In orchitis and epidydimitis, when the 
testicles are greatly inflamed and extremely 
tender to the touch, it affords relief when 
given locally and internally. 

622 W. 71st St., Chicago, 111. 



Alcohol is a well known remedy for 
burns from carbolic acid. It is said that 
cider vinegar is also a dependable local 
application to neutralize phenol burns. 
When the poison is swallowed dilute vine- 
gar is of value in conjunction with other 
remedies and measures. 

A recent amendment to the Pure Food 
and Drug Laws makes it an offense to put 
forth any false statement, design or device 
regarding the curative or therapeutic ef- 
fects of the contents of any package. This 
ought to prove a solar plexus blow to pat- 
ent medicines. 



TOXEMIA OF PREGNANCY WITH TH3 
REPORT OF A CASE. 

By E. N. Ritter, M.D. 

Very little space is devoted in most text- 
books to the toxemia of pregnancy. It is 
a subject which should interest every ob- 
stetrician. The poisonous substances are 
found circulating in the blood, affecting 
chiefly the kidneys, liver, spleen, and peri- 
pheral nerves, although lesions in other 
organs may be present. During the early 
part of pregnancy a rapid organogenesis 
occurs, thus often producing a faulty meto- 
bolism of the different organs. The organs 
of secretion and excretion become con- 
gested and their functions become impj^ir- 
ed and the toxic substances accumulate in 
the body. 

As to the etiology, pathology, symptom- 
atology, diagnosis, prognosis, prophylaxis 
and treatment is greatly varied, depending 
on the organ or organs most seriously af- 
fected. The most attention formerly was 
given to the kidneys, but I believe all or- 
gans of secretion and excretion are more 
or less involved. The beginning of preg- 
nancy is very frequently attended with 
nausea and vomiting, which is reflex in 
character, occurs in the multipara as well 
as the primipara. 

After the subsidance of the prdiminar)' 
nausea or vomiting, or both, a voracious 
appetite is often acquired. Occasionally 
large quantities of nitrogenous food is con- 
sumed, resulting in increased activity of 
the secreting and . excreting organs, in ad- 
dition to the gradual growth of the uterus, 
and ovum increases the katabolic work 
of these organs. The intra-abdominal 
pressure impedes the function of the ab- 
dominal organs, thus favoring the absorp- 
tion of the putrefactive products by the 
increased constipation of the bowels. The 
parturient does not exercise and her respi- 
ratory activity is hindered. The symp- 
toms varies in direct ratio with the in- 
tensity of the intoxication. The gastro- 
intestinal symptoms resemble that of "bil- 
iousness, i. e., nausea, vomiting, anorexia 
or pica, constipation, etc. 

The nervous symptoms are those of 
nervous irritability, alterations of charac- 
ter, headache, vertigo, insomnia, etc. 



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In exceptional cases there are no pro- 
dromal symptoms. The case I am about 
to describe is one of this character. 

Miss L., age 21. Primipara. Had con- 
sulted no doctor during her gestation. 
Living at home. Mother nor neighbors 
had not suspected her being pregnant. 
Saturday, April 29th, 4.30 A.M. 1 was 
called to admmister for cramps. Exam- 
ination showed OS dilated to the size of a 
quarter dollar, and labor pains occurring 
about every ten minutes. I returned home 
for my obstetrical bag and asked to be 
called when pains were of longer duration. 
At 8.30 A.M. I received a telephone mes- 
sage to come at once. On my arrival, 
which was five minutes later, I found the 
patient in the tonic stage of a convulsion. 
As soon as my hands were cleaned I again 
made a local examination, found os suffi- 
ciently dilated to "^pply the forceps. I 
asked for a consultant, but was refused. I 
then administered chloroform to quiet the 
patient, to aid in the application of the 
forceps and to increase the flow of blood 
from the uterine cavity, which I had ob- 
served occurs when administering chloro- 
form during labor. The forceps delivery 
of a living, healthy boy baby was quite 
easily accomplished with a slight lacera- 
tion, which was at once repaired. As the 
amount of blood lost was greater than I 
had expected, I inserted one hand in the 
uterine cavity while the other remained on 
the abdomen, but the uterus was flabby 
and would not contract. I ordered a tea- 
spoonful of ergot by mouth, which the pa- 
tient swallowed. Finally the uterus began 
to contract on my hand in the uterine cav- 
ity and the flow lessened. Pulse was now 
120, patient unconscious, convulsions re- 
curring from five to ten minutes. I gave 
ten to twenty drops of veratrum hypoder- 
mically every fifteen minutes until the 
pulse came down to forty-four. I gave 
two drops of croton oil in a little castor oil, 
which was repeated in four hours. An en- 
teroclysis of three quarts of normal salt 
solution was given and retained. As the 
convulsions returned every few minutes 
the family finally consented to have a con- 
sultant, who arrived about noon. Another 
salt enema was advised, but as the 
sphincter ani was completely relaxed it 
could not be given. A submammary hy- 



podermoclysis of a quart of saline solu- 
tion was given and repeated in two hours. 
A grave prognosis was made by the con- 
sultant as well as myself. Hot water bot- 
tles and hot irons were applied near the 
patient to get the skin acting. The pulse 
was gradually ascending, even under larger 
doses of veratrum at longer intervals, the 
breathing rapid and very noisy, as if much 
mucus was in the pharynx; 5 P.M. bowels 
not moved, rectal tube inserted and a high 
enema of glycerin and magnesia sulphate 
administered. Some fecal matter was ex- 
pelled with a large amount of gas. Patient 
catheterized soon after delivery and every 
four hours thereafter. First specimen of 
urine contained fifty per cent, albumin. 
10 P.M. pulse 142. Thirty drops of vera- 
trum hypodermically ; perspiring very 
freely. Last convulsion occurred at 10.30 
P.M. Axillary temperature 105. Pulse 
152. Respirations 60 and very noisy. A 
hypodermic of morphine gr. J4» atropine 
gr. 1/150 administered to quiet the breath- 
ing if possible. April 30th, 12.30 A.M. re- 
turned home, leaving nurse in charge with 
no final instructions, as end was apparently 
inevitable and nothing more done except to 
catheterize. 3 A.M. breathing became 
quiet. 4 A.M. pulse 144, axillary tempera- 
ture 103, respirations 52. 

At 10 A.M. I was surprised to find the 
patient living. Pulse 136, axillary tem- 
perature 100, respirations 36. As there 
had been no stool except the one following 
the enema yesterday, another enema of 
salt and glycerin was given with a very 
effective bowel movement. Catheterized 
now only every six hours. Patient still 
unconscious, but would swallow a tea- 
spoonful of water when placed in the 
mouth. Prescribed veratrum thirty drops 
and echinacea one dram to four ounces of 
water; of this a dram every hour. 5 P.M. 
axillary tempetarure 99 2/5, pulse 120, res- 
pirations 38. Quite restless, so ordered 
morphine and atropine for the night. 

May 1st. Rested quite well on the hypo- 
dermic during the night, but coughed con- 
siderable; urinates involuntary. 10 A.M. 
temperature 993/5, pulse 124, respirations 
34. Added specific bryonia and specific 
podophyllum, of each ten drops, to the 
veratrum solution and a dram every two 
hours. Rales in both lungs. Buttermilk 



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THE MEDICAL SUMMARY 



was given every two hours. Consumed two 
glasses of buttermilk during the day. 

9 P.M., axillary temperature loi 1/5, 
pulse 128, respirations 48. Stools invol- 
untary and expells gas freely. 

May 2nd. 10 A.M., temperature 994/5, 
pulse 104, respirations 45. Rested quite 
well during the night without morphine. 
9.30 P.M., temperature loi 1/5, pulse 126, 
respirations 52. Added strychnine gr. 1/50 
every four hours. 

May 6th. Temperature by mouth loi 
at 8 A.M., pulse 112, respirations 36. Asked 
for bed-pan, complains of pain all through 
body; can speak only in a whisper. 

May nth. Pulse no, temperature 994/5, 
respirations 28. Only a slight ring of al- 
bumin on examining urine with nitric acid. 
May 19th. Pulse 98, temperature 99 2/5, 
respirations 30. Stopped strychnine and 
gave arsenic iodide gr. 1/50 three times a 
day. Talked aloud yesterday. 

May 28th. Temperature 983/5, pulse 
90, respirations 26. Lungs clearing up 
slowly, but has long coughing spells. 
Protonuclein six grains three times a day. 
June 5th. Pulse 78, respirations 24. 
Able to move down stairs. 

This has been a very interesting case to 
me, owing to the sudden and severity of 
the attack. She had more than 70 convul- 
sions, beginning at 8.30 A.M. and continu- 
ing until 10.30 P.M. The interval of con- 
vulsions were from five to ten minutes. 
The number was not recorded, as the 
nurse was busy in administering chloro- 
form at intervals, guarding the tongue 
from the teeth, applying heat catheterizing, 
assisting in administering, enteroclysis, hy- 
podermoclysis, etc., besides the unfavorable 
prognosis, a minute record was not consid- 
ered necessary. The most important part 
of the treatment was the late use of mor- 
phine, thereby not locking up the secretions. 
The first thought in the treatment of tox- 
emia of pregnancy is the elimination of 
the poisonous substances in the system, the 
convulsions are only symptoms and need 
not be treated, as they will subside when 
the cause has been removed. Never use 
morphine in the beginning of puerperal 
convulsions. 

Williamsport, Pa. 



THE SYSTEMS OF MEDICAL PRACTICE. 

(Continued from page 178, August Number.) 

By G. Curson Young, M.D. 

After the death of Galen, in the latter 
part of the second century or commence- 
ment of the third, the Roman Empire be- 
gan to decay. The general interest in the 
arts and sciences as years passed by, gave 
evidence of a gradual wane, and medicine 
was one of the first of the liberal arts to 
suffer neglect. The conflict between the 
Christian religion and Pagan doctrines 
was the uppermost subject for both mental 
and physical activity. Under emperor 
Constantine a change took place, and the 
Asclepion temples gave way to charitable 
institutions and hospitals, in which priests 
were installed to minister to both, the 
physical and spiritual* needs of man. The 
clouds now began to hover over the medicd 
practice, and the systems became very 
much degraded in the choice of remedies. 
The herb was largely forsaken and animal 
products were used to the horror and dis- 
gust of the sick. One can mention but few 
things in the animal, and not many in the 
vegetable kingdom that has not at some 
time been used as a remedy for some dis- 
ease, but from the fourth century down to 
the fifteenth, the animal was largely in 
the favor of physician and dread by the 
people. 

It is true we no longer hear of the 
balsam of bats, or of the pulverized hu- 
man bone, or the flesh of a healthy young 
man, dying about the middle of August, 
being used as a medicine; earth worms, 
suckling whelps, the marrow of the thigh 
bone of a stag, bed bugs, the virus of rep- 
tiles, excrements from the human and 
other animal bodies, and a hundred other 
disgusting things such as we are unwilling 
to record. But did they outrage all de- 
cency, science and reason to much greater 
degree than is being done at the present 
time? 

It seems so strange that men who are 
supposed to possess ability as medical men, 
should pass over hundreds of natural reme- 
dies for almost every disease and yet turn 
to things unnatural. Suppose some good 



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results follow the use of animal therapeut- 
ics once in a while, and nature's vegetable 
kingdom would have done as much and 
more, what have you gained? Not that 
laboratory work has been all in vain, but 
clinical work has done a thousand times 
more for the sick than it is possible for the 
laboratory to do. 

Mercury, bleeding, blistering and opium, 
— ^the charlatan's quartet, is less popular 
now than in the dark ages. In the six- 
teenth century hot fomentations, hot baths 
medicated with herbs, roots, barks and 
flowers were much in use, and from this 
time on every baron had his monk phy- 
sician, as a resident under his roof. From 
a scientific standpoint the monk system of 
practice was a great improvement, and 
more specific; one dose of a decoction of 
some herbs, and then wait some few hours 
for results, keeping the patient under ob- 
servation; when results were favorable, 
another dose of the same medicine was 
given; if not favorable some other was 
used such as was thought to be indicated. 
Boerhaave, 1668, mastered many prob- 
lems in the systems of medicine, and in his 
lectures at Leyden he advocated the rela- 
tionship of the chemical constitution and 
physiological action of drugs, but his sys- 
tem of practice was largely theoretical. 

Von Haller, 1708, advanced botany, 
chemistry, physiology, pathology, and 
therapeutics beyond any one since the time 
of Celsus, but his system of practice was 
so hypothetical, and his philosophy so pro- 
found, that he did not have a large follow- 
ing. Haller's mental reasoning respect- 
ing the action of organic medicine border- 
ed close onto the doctrine of organic rein- 
carnation; thus the Convallaria, to the 
eye a thing of beauty, to which the robes of 
Solomon did not compare, to the nostril an 
odor almost divine, to the heart, a solace in 
its organic derangements, almost unequal- 
led. No wonder Haller was almost ready 
to believe that Canvallaria Majalis was the 
reincarnation of some celestial virtue, hav- 
ing done so much for man for thousands 
of years, and is yet as beautiful and as 
useful as ever. Haller loved plants, and 
used them to cure the sick, as his system of 
practice. 

Dr. William Cullen, 1735, founded a 



new system of practice of medicine, on a 
new pathological basis. It was known as 
the doctrine of ''Irritability" which 
abounded in new theories. He regarded 
the condition of the practice of medicine 
as he found it, burdened with what he 
called "False Facts," full of hypothetical 
mazes, but the Cullen system, as he 
taught it in Edinburgh, was not free from 
mazes, especially that part which relates 
to the influence of the nervous system be- 
ing alike in healthy and morbid action. 

Dr. Cullen was a learned man, and a 
physician who labored for the improvement 
of the profession, and for that purpose he 
put forth a new system. . 

John Brown, a contemporary of Pro- 
fessor Cullen, concentrated Cullen's sys- 
tem in ''Brunonian theory," according to 
which no change can take place in the 
state of the excitable powers without pre- 
vious excitement, and it is only by over- 
excitement that the excitability, with life, 
can be exhausted. 

The materia medica prepared by Pro- 
fessor Cullen was the cause of Dr. Hahne- 
mann founding his system of Homeopathy, 
near the end of the seventeenth century. 
Hahnemann was forcibly struck by the 
contradictory accounts given of the prop- 
erties of Peruvian bark, and after doing 
some thinking he arrived at the conclusion 
that any drug which would produce symp- 
toms of a disease in a healthy body, that 
same drug would cure that disease in a sick 
body. Hahnemann had previously medi- 
tated much on the unsatisfactory nature 
of the science of medicine, and after much 
reflection and many experinemts he be- 
came convinced of the truth of the princi- 
ple, Similia Similihus Curantur, and that a 
large dose produced symptoms of unnec- 
essary violence and danger. This led to 
another principle, that the minimum dose 
of medicine affords as much benefit as the 
conventional dose. This was a radical 
change from Contraria Contrariis. It was 
a great changre 

In this seventeenth centur}' two g^reat 
medical reformers were bom, — Hahne- 
mann, 1755. and Samuel Thomson, 1769, 
both of whom created a mighty commotion 
in the world of medical practice. They 
were contemporary, but wide apart in their 



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THE MEDICAL SUMMARY 



conception of the change so much needed 
in the practice of medicine. 
Washington, N. J. 

(To be concladed in November issue.) 



A CONTRIBUTION TO THE STUDY OF 

HERNIAS OF THE OVARY, TUBE, 

AND TUBE AND OVARY. 

By Aime Paul Heineck, M.D. 

Surgeon to the Cook County Hospital, Chicago. 



In the female, the frequency of hernias, 
and especially the hernias of the internal 
genitalia, has been and is still underesti- 
mated. Owing to the lack of study here- 
tofore given to this clinical entity, hernias 
of the uterine adnexae are often overlooked, 
not uncommonly misdiagnosed, and there- 
fore subjected to injudicious treatment; 
harmful alike to the individual and to the 
hernial contents, prejudicial alike to the 
patient's general well being and to her re- 
productive powers. Impressed by the clini- 
cal importance of the condition and sur- 
prised at the insufficient consideration 
given to the subject in even the most mod- 
ern gynecological and surgical text-books, 
I have collected the following data which 
may prove of service to some of my pro- 
fessional colleagues as well as to future 
investigators of the subject. Knowledge 
of the occurrence and familiarity with the 
symptomatology of the clinical condition 
lead to its more frequent and more timely 
recognition. 

Soon after beginning the consideration 
of the subject, we became convinced that 
deductions and conclusions to be valuable, 
should be based solely upon the study of 
cases whose accuracy of diagnosis is self- 
evident. Therefore in the preparation of 
this paper we have only considered cases in 
which the hernial contents were demon- 
strated at the dissecting, autopsy or oper- 
ating table. 

We have conformed to the nomenclature 
in actual use; however, to better insure 
precision of classification and a more intel- 
ligent discussion of the subject, we define, 
at times, perhaps needlessly, the terms em- 
ployed. The word hernia signifies the per- 
manent or temporary protrusion of one or 
more viscera from their normal situation 



through a normal or abnormal opening in 
the walls of the cavity within which they 
are contained. It implies the existence of 
a hernial rmg, or a hernial sac, or hernial 
sac contents and of sac coverings. In the 
hernias discussed in this article, the pro- 
truding organ was always either an ovary, 
an oviduct, or fallopian tube and an ovary. 
In some cases, as associated hernial con- 
tents, we find omentum, a segment of the 
alimentary canal, a part of the urinary 
bladder, a rudimentary uterine horn, or the 
entire uterus, be the latter organ rudiment- 
ary, infantile or of normal development 
The tube or ovary, or both, in part or in 
their entirety, may be herniated. All the 
hernias herein considered are external 
hernias; that is, their outermost overlying 
saccular covering is skin, and each, after 
reaching a certain stage of development, 
gives rise to a more or less visible, more or 
less palpable external swelling in the in- 
guinal, femoral, ventral, obturator or ischi- 
atic regions, depending upon the. anatomi- 
cal location of the hernia. Internal hernias, 
that is, hernias in which one ©r more loops 
of intestine find their way into pouches or 
recesses in the posteriar peritoneal wall, 
and diaphragmatic hernias, be the latter 
true or false, congenital or acquired, con- 
stitute other chapters of surgery. 

The escape of the uterine appendages 
from their normal situation may take place 
through any of the spots or openings of 
the lower abnominal or abdomino-pelvic 
cavities. A hernia originating either in 
the internal or in the external inguinal 
fossae and escaping above Poupart's liga- 
ment is an inguinal hernia; if escaping be- 
neath the same ligament, it emerges through 
the crural canal and the saphenous opening, 
it is a femoral hernia; if through the ob- 
turator canal, an obturator hernia : if along 
the course of the gluteal or sciatic nerves 
and vessels, emerging almost always above, 
very infrequently below the pyriforrais 
muscle, very rarely through the lesser 
sacro-sciatic foramen, a gluteal hernia; 
if through an operative scar in the abdom- 
inal wall, a post-operative hernia. 

Though sanctioned by long usa^C the 
classifying hernias into congenital and ac- 
quired is, at times, misleading. It is mis- 
leading because it is practically impossible 
to determine the congenital or accjmred 



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nature of many hernias. Furthermore, the 
term congenital hernia, as now used, does 
not imply in the female that the hernia was 
present at birth, as it is also applied to 
hernias whose post-natal development is 
due to predisposing conditions of congeni- 
tal origin; developmental defects, persist- 
ence of transitory embryonal or fetal 
states which, owing to their non-disappear- 
ance with growth, permit the occurrence 
of outward visceral displacements. Some 
hernias are congenital in the truest sense 
of the word; they are complete at birth, 
hernial contents being then present. In 
most of the so-called congenital hernias, 
the sac only is existent at birth; in an ac- 
quired hernia, the sac is always of post- 
natal development, and in all but hernias 
par glissement is entirely derived from the 
parietal peritoneum. Congenital hernial 
sacs result from the want of closure of 
peritoneal processes, such as the processes 
vaginalis peritonei in the male, the canal 
of Nuck in the female, etc., normally pres- 
ent in the fetus. Congenital hernias may 
appear at any period of life. 

Orifices for the transmission of vessels 
and ducts are normally present in the mus- 
cular and aponeurotic layers of the abdom- 
inal walls. An acquired hernia is formed 
by the gradual or sudden escape through 
these orifices, pathologically widened, of 
viscera normally contained within the ab- 
dominal cavity; the viscera in their pas- 
sage through and beyond the abdominal 
wall create paths of escape for themselves 
by bulging and pushing forward the parie- 
tal peritoneum. 

In many cases, the congenital or ac- 
quired nature of the hernia is either too 
vaguely stated or is left unmentioned. 
Femoral hernia seldom occurs before adult 
life. 

Tubal, ovarian and tubo-ovarian hernias 
occur in the colored and in the white race. 
Commonly, the condition is unilateral; in- 
frequently, it is bilateral. When bilateral, 
the hernias may or may not be developed 
to the same degree on both sides. The hi- 
laterality may date from birth: may be 
acquired. In the latter case, the hernias 
from the first have been bilateral or an in- 
terval of time of shorter or greater length 
may have intervened between the aopear- 
ance of the two hernias. In Broca's case. 



when patient was eight months old, the 
right inguinal hernia appeared, but the 
left inguinal hernia did not become mani- 
fest before the patient was four years of 
age. All the bilateral tubal, ovarian, or 
tubo-ovarian hernias recorded in the medi- 
cal literature of the last twenty years are 
of the inguinal variety. This is in accord 
with a well-known fact that, in both sexes, 
double femoral hernias are less frequent 
than double inguinal hernias. 

A tubal, an ovarian or a tubo-ovarian 
hernia may co-exist with one or more her- 
nias of other organs. Multiple hernias are 
not infrequent, the hernias present being 
either of the same or of different types, as 
two inguinal hernias or one inguinal and 
one femoral hernia on the same or on op- 
posite sides of the body. 

The hernias which we have under con- 
sideration may or may not be associated 
with non-development, malformation or 
absence of the other internal or of some 
external genitalia. In Martin's (Koss- 
mann) case, hernia of the left tube and 
ovary, the uterus was displaced upwards, 
forwards and to the left by a cyst of the 
right ovary having the volume of a man's 
head. 

In almost all the cases the operation per- 
formed was a herniotomy, and as herniot- 
omy affords little opportunity for direct ex- 
amination of the pelvic organs, the condi- 
tion of the non-herniated genitalia was de- 
termined in only a few cases. 

Hernia is a widespread disease. The 
relative incidence of hernia of the internal 
genitalia as to age corresponds to that ol 
hernia in general. In our series, the 
youngest patient was four weeks old ac 
time of operation. Nicoll operated suc- 
cessfully for ovarian hernia on two infants 
each one and a-half months old. The old- 
est patient operated on was seventy-eight 
years old. She had a left tubal obturator 
hernia. Lickley reports a right tubo-ovar- 
ian obturator hernia observed in a dis- 
secting room subject who had died of gen- 
eral debility and hemiplegia at the age of 
eighty-seven years. In many cases, the 
age is not stated. The age given by most 
authors corresponds to the age of the pa- 
tient at the time of operation 

The study of the reported cases demon- 
strates : — 



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THE MEDICAL SUMMARY 



(a) The frequency of hernias during 
the first year of life. 

(b) The rarity of the condition from 
the first to the fifteenth year of life. 

(c) The noticeable progressive in- 
crease in the number of hernias ob- 
served from the fifteenth year on, the 
maximal frequency being seen during 
the fourth decade of life. 

(d) After the fortieth year, there is a 
decline of the number of hernias; they 
become relatively rare as the extremes 
of life are approached. During the 
child-bearing period, hernias of either, 
or of both uterine appendages have been 
observed in nulliparae, in primiparae, and 
in multiparas 

Etiology. — The predisposing and excit- 
ing causes of tubal, ovarian and tube- 
ovarian hernia are shown by an analysis 
of the collected cases to be the same as 
those of other hernias in the female. The 
persistence of the canal of Nuck is an eti- 
ological factor of the greatest significance 
in the causation of inguinal hernias. The 
canal of Nuck, the homologous of the pro- 
cessus vaginalis peritonei in the male, is a 
peritoneal diverticulum accompanying and 
adhering intimately to the round ligament, 
descending in some cases as far as the in- 
sertion of that ligament in the labium 
majus. This peritoneal process, whose 
dates of origin and disappearance are not 
accurately known, is usually found com- 
letely obliterated at birth; it may close 
after birth ; it may even persist throughout 
life. When the canal of Nuck is only par- 
tially are completely unobliterated, it forms 
a potential hernial sac and is conceded to 
be the most important congenital predispos- 
i ig cause to inguinal hernia formation. It 
is a matter of common knowledge that 
preformed sacs are not of frequent occur- 
rence in the inguinal region. They have 
bpen found in other hernial regions. A 
sudden or forcible increase m intra-abdomi- 
nal pressure, such as can be determined by 
muscular effort, by a misstep in an attempt 
to save one's self from falling, can lead to 
hernia formation by causing the irruption 
in a preformed sac of a tube, an ovary or a 
tube and ovary. As during infancy, Ihe 
internal genitalia can neither be displaced 
by their physiological activity, which is nil, 
nor by the development of pelvic tumors 



(rare during early childhood), nor by mus- 
cular ^lort, it follows that hernias of the 
uterine appendages, at that period of life, 
are due to such congenital anatomical de- 
lects as facilitate tubal, ovarian or tubo- 
cvarian dibplacement. 

ThoLigh, aa an etiological factor in the 
production of hernias, the existence of 
hereditary predisposition is denied by some 
authors, to us, t!ie influence of heredity 
appears positive. Hernia being a malform- 
ation often due to developmental arrest, 
such as non- or incomplete obliteration of 
the processus vaginalis peritonei, non-ob- 
literation of umbilical ring, etc., it is sub- 
ject to hereditary transmission. It is rea- 
sonable to assume that like structural 
characteristics beget a like predisposition 
and a like resistance to hernia develop- 
ment. Among other etiological factors 
should be mentioned: — 

1. All conditions associated with in- 
creased mobility of the uterine appendages: 

(a) Lengthening of the broad liga- 
ments consecutive to repeated pregnan- 
cies. 

(b) Pathological relaxation of the lig- 
aments due to puerperal sub-involution. 

(c) Abnormal length of the broad, 
ovarian and infundibulo-pelvic ligaments. 

(d) Relaxation of the other tubal, 
ovarian and uterine ligaments. 

2. All conditions that tend to increase 
the intra-abdominal pressure: 

(a) By overcoming the resistance of- 
fered by one or another of the weak 
points of the abdominal wall. 

(b) Occupations necessitating repeat- 
ed muscular efforts associated with in- 
creased intra-abdominal tension, as the 
lifting or pushing of heavy weights, etc 

(c) Physiological or pathological 
states which distend the abdominal cav- 
ity, which stretch the abdominal parietes 
and widen the orifices normally present 
in the muscular and aponeurotic layers 
of the abdominal wall: — Enteroptosis, 
obesity, abdominal tumors, ascites, preg- 
nancy, etc. 

3. All conditions which weaken the ab- 
dominal wall. 

(a) Acute or chronic disease debili- 
tating the organism. 

(b) Obesity. 

(c) Traumatism. 



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239 



(d) Enteroceles,cpiplocclcs and entero* 
«piploceles. 

(e) Feeble development or atrophy of 
the aponeurosis of the transversalis 
muscle and of the conjoined tendon. 

(f) A shortening of the round liga- 
ment of the hernial side. 

Hernial Sacs. — Congenital hernias have 
sacs of pro-natal formation. That the canal 
of Xuck remains patent in many cases long 
after birth, even into adult Hie, has been 
proven by a number of investigators. Ac- 
quired hernial sacs are lormed of parietal 
peritoneum forced by intra-abdominal 
pressure through some congenital or ac- 
quired defect in the abdominal walls. 

In the female the following anatomical 
characteristics are strongly suggestive of 
the congenital sacs: — Great vascularity, 
absence of sub-serious fat, folds, valvular 
or diaphragmatic constrictions, cyst-forma- 
tions, scar-like induration of the wall, etc. 
In congenita] inguinal hernias, it is also 
noted that the round ligament is intimately 
adherent to the sac. 

As we see, the sac results from the 
bulging outward of the parietal peritoneum 
without solution of continuity. It consists 
of a neck, body and fundus. Of these 
three, the neck is the most imoprtant. It is 
through it that the general peritoneal cav- 
ity communicates with the hernial sac cav- 
ity. It may be the site of constriction. The 
fibrous envelope of the sac is due to the 
condensation of the fibrous layers which 
the hernia in developing pushes forward. 

The internal surface of the sac, 
whether the latter be congenital or ac- 
quired, has all the peculiarities of serous 
membranes. 

In the female, encysted inguinal hernias 
result from partial closure of the canal of 
Nuck, the peripheral portion of which is 
transformed into a cyst in which a de- 
veloping hernia prolapses or from the sink- 
ing of a hernia in pre-existing hernial hy- 
drocele. 

There is really no sacless hernia ; but the 
herniated viscus may be an organ only 
partially covered with peritoneum. 

In sliding hernias, the anterior and lat- 
eral portions of the sac are, as in ordinary 
hernias, derived from the perietal perito- 
neum, while the remaining portion is 
formed by the anterior surface of the her- 



niated cecum, sigmoid, bladder or fallopian 
tube. 

Hernial sacs may be dome-sLaptd, cyl- 
indrical, digitiform, sacculated or irregular; 
may show constrictions with intervening 
dilated portions. Most femoral sacs are 
small and not infrequently are embedded 
in a mass of fat. The sac in recent her- 
nias may be very thin. In children and in 
young infants, sac is extremely thin. 

Hernial Fluid. — The reporters not infre- 
quently state that fluid of some nature or 
other was present in the hernial sac. The 
fluid may be serous, sanious, muco-puru- 
lent, purulent or fetid in character. 

HERNIAL SAC-CONTENTS. 

Tubal Hernias. — The tube, either in part 
or in its entirity, may be the sole content 
of the hernial sac. As associated hernial 
contents, a portion of the urinary bladder, 
normal intestine, gangrenous intestine and 
omentum were noted. 

The herniated tube may be normal and 
free; may be adherent to sac; may be 
strangulated; may show inflammatory les- 
ions; may be cystic; may be the seat of a 
pyosalpinx. 

Ovarian Hernias. — The ovary may be 
the only content of the hernial sac; or may 
be associated with a systic parovarium, 
with omentum, with intestine or with a 
rudimentary uterus. The herniated ovary 
is reported as being in some cases normal, 
in others enlarged to twice its normal size, 
infiltrated with blood, the scat of a large 
hematoma, adherent to sac, systic, to have 
presented areas of suppuration, to have 
shown gangrenous changes. 
1908 S. Trumbull Ave., 
Chicago, 111. 

(Tj b; Continued.) 



Numerous free dispensaries are being 
opened in many places in the south for the 
cure of the hookworm disease. The treat- 
ment is simple and safe. It consists of a 
morning dose of salts followed by an all- 
day fast, then 30 to 60 grains of thymol in 
capsules at bedtime and salts again the 
next morning. 



In children, in cases of peritonitis of un- 
known origin, examine for gonorrheal 
vulvo- vaginitis. 



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THE MEDICAL SUMMARY 



THE PRACTICAL APPLICATION OF ELEC- 
TRICITY AS A THESRAPEUTIC AGENT.— 
GENERAL USE OF CURRENTS. 

By J. R. Etter, M.D. 



EDITOBIAI. NOTE.— This is the flftli of Dr. Elter's 
series of short, practical articles. Each arti- 
cle will be complete In Itself; the entire series 
when complete, will form a regular vade-mecum 
on "The Practical Application of Electricity as 
a Therapeutic Agent." These articles wiU be 
something different, that Is, they will be pre- 
sented in a different form from the general run 
of matter hitherto brought out on the subject in 
the books. No general practitioner can afford to 
miss a single number of The 8UMMABT contain- 
ing this Series, which will run through all the 
present year (omitted in September issue) and 
probably the next, and will give the technique 
of application minus the theory. 



Instruments. — The instruments needed 
in electrical treatments will depend solely 
on the class of work the practitioner desires 
to do. One cannot take a skiagraph with 
a Faradic battery, neither can he perform a 
cautery operation with a static machine. 
With a good Galvanic and Faradic machine, 
one can cover a very extensive field of 
work, and, when I say a "good" machine, I 
mean one that has sufficient strength and 
the proper controlling devices so that the 
currents may be under perfect control, from 
the weakest to the strongest currents de- 
sired to be used. A machine should be so 
arranged that all switches are in easy reach 
while treating the patient that the current 
may be varied at will. Each treatment 
should be begun with a very mild current 
and gradually increased to the desired 
point, or to the point which the patient will 
readily bear. The amount of current a 
patient will bear one day, is but little guide 
as to what they will bear the next day, as 
has been observed by me in hundreds of 
cases. I used to get irritated at my pa- 
tients on this account, and try to force the 
current up to the same standard each sit- 
ting, but learned by sad experience that it 
was a good way to drive them away, and of 
course the reputation as well as the money 
was at an end. For your own good and the 
good of the patient, it is best to stop when 
you have carried the current to the point 
your patient will reasonably bear at each 
sitting, and as a rule the less argument you 
produce, the better off you are, as the pa- 
tient will feel that you recognize their pe- 
culiar nervous conditions from time to 



time. Basing my practice upon the above 
observation, I seldom use a meter, as the 
patient is the best meter one can have, ex- 
cept perhaps in electrolysis, where you 
cannot observe the effect of the electrode 
in situ, but of this I shall speak again. 
After obtaining a good machine, the next 
thing of greatest importance is, to sec 
that it is kept free from dust and that all 
connections are kept tight. Electricity, of 
all the motor agents we have, is the most 
certain to work when in order, and, per 
contra* the smallest thing will prevent it 
from doing what you want it to. The 
slightest loose connection, either in switch- 
board or wire attachments, will block the 
whole game, and you are ready to say that 
electricity is too uncertain a quantity to be 
depended upon, when in fact the fault is all 
your own. 

Where a machine is run with battery 
power, I much prefer what are known as 
"Dry Cells," as they are very powerful, 
constant, and can be replaced by the phy- 
sician without the aid of an electrician, 
which, at best, is generally a very expensive 
luxury. Tihe cells should be so arranged as 
to be easily examined. One bad cell in a 
battery will prevent the good ones from 
working, as the resistance is ofteii too 
great for the current to pass through. If 
your machine fails to work, the first thing 
is, to be sure that your switches are set 
right for the current desired, as I have 
found in my own experience, when my ma- 
chine failed to go, that some switch was 
not on the proper point, although it was a 
machine I had used for years and was per- 
fectly familiar with. The next thing is to 
see that all connections are tight, the 
trouble will most likely be in the cells. 
With a small volt meter, you can test each 
cell separately, or with a buzzer, or even a 
door-bell, you can get a very good idea as 
to the condition of the cells. Where you 
use "dry" cells, if one becomes deficient, 
you can replace it with a new one, without 
disturbing any of the rest, but in doing so, 
you should take out one cell and replace 
it, connecting the wires up as they were 
before. If you remove two or three cells 
at a time, you are liable to get your wires 
mixed up, and the connections will not be 
right. Always notice particularly which 
wire is attached to the carbon element be- 



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241 



fore disconnecting, and connect it back to 
the carbon of the new cell. A new ma- 
chine is more liable to get out of order, 
than one that has been used for some time, 
as the maker may have failed to get all 
connections tight as they should be, and 
the first user of the machine will most 
likely discover them, so don't condemn a 
new machine because it may fail to work 
just right. 

There are electrodes and electrodes on 
the market, and it is one of the things that 
deter many physicians from attempting the 
use of electricity, as they glance over a cata- 
logue and see so many attachments and then 
read the technical books, they at once be- 
come discouraged as to ever being able to 
grasp the idea of electrical treatment. 
Many manufacturers of medical machines, 
have seen fit to put the most cost in elec- 
trodes, and overlook the necessity of the 
real machine. In these articles, from place 
to place, I shall endeavor to make sugges- 
tions how a physician can utilize many of 
the instruments that he already has, and in 
many instances to much better advantage 
than in the set electrodes that have been 
invented from time to time. Then again, 
many of the electrodes have been invented 
along "theoretical" lines, instead of prac- 
tical ones. My whole aim will be to sim- 
plify the use of electricity in medicine, 
rather than to cloud it with finespun theo- 
ries, as is often done. An old saying is, 
"Nothing succeeds like success," and this 
is forcibly exemplified in the cvcry-day use 
of electricity in the treatment of disease. 
If you get results, regardless of the fine- 
spun theories, your patients will be satis- 
fied and pay their bills. This may seem 
to be a commercial view of the matter, but 
it is not altogether so. What you want, 
and what your patients want, are one and 
identically the same. You want to be suc- 
cessful and your patients want to be cured 
of their ills. If you are successful, your 
patients will pay their bills with gratitude, 
and this should be the highest aim of the 
physician. 

Charlatanism may win for a time, but it 
will not last. I knew a man who located 
in a town and had enough money to pur- 
chase an X-ray machine. Every patient 
who came into his oflfice, he would turn on 
the machine and tell them that he could 



see every organ of the body and know just 
what condition it was in — could tell 
whether the valves of the heart were work- 
ing just right, whether the liver was sepa- 
rating the proper amount of bile, could see 
the amount of uric acid passing through 
the kidneys, tell which testicle furnished 
spermatozoa and which ovary was product- 
ive, and in fact could just read the whole 
human anatomy and physiology and diag- 
nose all diseases by the X-ray. For a 
while he succeeded in gulling the people, 
and demonstrated his great superiority over 
the common physician. His stock in trade 
was to show how little other doctors knew, 
in fact, he was it. But time moved on 
apace, and other doctors who had studied 
the X-ray, began to educate his patients, so 
it was not long till he had to drop his 
Charlatanism. Then he went the way of 
all who try to deceive the sick and af- 
flicted. They have their day for a while, 
but the time comes when they have to 
change location and seek a new clientele. 
In the long run, honesty is the best policy. 
It is not necessary to tell your patients that 
you can surely cure them with electricity, 
but tell them that in the given condition it 
is the best hope of recovery, or that it is a 
great adjunct to their recovery. If you 
make a hobby of any one thing, you will 
lose out; but, on the other hand, if you 
use all the accessories for the good of your 
patients, you will be the successful prac- 
titioner. It is just as much folly lo expect 
to cure everything with medicine, as it is 
to cure everything with electricity — neither 
will be a success. Even suggestion has a 
great field, whether given in connection 
with medication or electricity, yet it is not 
the whole thing, as some would make be- 
lieve. If you have two good remedies at 
hand, that will not conflict, use them, even 
if the books do not say so. Nature has 
many and various ways to remedy the 
evils of the flesh, and possibly many hob- 
bies. The successful physician studies • 
the various phases of his patient, and fits 
his remedies accordingly. No two are ex- 
actly alike. There are many conditions 
that electricity will not meet, and in such 
we must resort to medication or surgery, or 
both. All remedies known have their field, 
and it is just as foolish to depend alone on 
one as on the other. Electricity, where it 



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THE MEDICAL SUMMARY 



is indicated, is one of the surest that we 
have, and at the same time will give the 
quickest results. It cannot be used hap- 
hazard with any prospects of benefit, but 
must be used intelligently, the same as 
other remedies. 

I do not expect to give minute direc- 
tions for treating each separate disease 
with electricity, but will take up enough 
separate kinds and discuss them, that the 
practitioner will have no trouble in applying 
the remedy to all forms where it is indi- 
cated. 

Crawfordsville, Ind. 



THE AUGUST SUMMARY. 
By George L. Servoss, M.D. 

In the middle of summer, especially dur- 
ing *'dog days," one anticipates but little of 
anyone requiring great effort, but our 
Editor seems to be just as wide-awake this 
summer as he was during the colder months 
of the past winter. In speaking of apo- 
morphine, as an emetic, I would add to the 
editorial remarks that it would be well to 
be careful in the use of this agent in nar- 
cotic poisoning, as its late use might add to 
the narcosis. Such things have been known 
to occur. Why not use a good stovaine 
preparation instead of cocaine in catheter- 
izing? How would quinine and urea hy- 
drochloride act? Iodine is surely doing 
wonders, and we thank the Editor for his 
remarks relative thereto. Nothing missing 
at all as regards obstetrical equipment. 
The young man should clip and file this edi- 
torial, even though it may contain nothing 
new to him. It will act as a reminder. The 
remarks regarding spermatorrhea are good 
and to the point, and should be read without 
passing. As usual the Editor makes some 
very pertinent remarks regarding eye reme- 
dies. Just little simple things, but ones, 
properly used, which will bring order out 
of chaos in many cases. Turpentine is an 
old "home remedy,' but one worthy of more 
than passing attention, and every doctor of 
the Summary family would do well to read 
this column, as he may discover something 
with which he was not conversant. 

Coming to the original articles, Etter, as 
usual, handles the question of the Faradic 
current in a masterly manner, and this arti- 



cle, even though somewhat brief, should be 
01 general niterest, especially to those 
readers who have not had the advantage of 
a complete course of instruction in electric- 
ity. 

Kirk, in his remarks regarding dysen- 
tery and summer diarrhea, gives us quite a 
list of the different remedies employed in 
such conditions, and his article is well writ- 
ten. 1 would suggest that, in the treatment 
of these disorders, as in all other patho- 
logic conditions, the remedies for certain 
specific indications would be practical. 
Kirk pays some attention to indications, but 
not enough. We are forgetting names of 
diseases more and more, as time goes on, 
and are treating the indications, of an indi- 
vidual character, rather than the diseases 
in their entirety. 

Redfield is surely giving us an instructive 
series of articles relative to the active prin- 
ciples ; one worthy of clipping and filing for 
future reference. The active principles 
are becoming more popular as they are 
better known, and Redfield is giving us val- 
uable additions to such knowledge. 

Of course, Souders did not intend to give 
us anything really medical. His little arti- 
cle, "An Every-day Philosopher," serves 
to act as an oasis in the desert of dry med- 
ical thought. More such articles would be 
welcomed. 

Now, it would not be nice at all for Ser- 
voss to say anything about the next article, 
but I would emphasize the facts therein, 
that there is such a thing as scientific thera- 
peutics, and that they should be more thor- 
oughly thought of. 

Sprague has given us another oasis in 
"A Few Reflections," which is undoubtedly 
pleasing to those who delight in the poetic 
muse, especially that of an amusing nature, 
as is the poem by Doctor Wiley. 

Young has given us some very interest- 
ing data, of an historical nature, relative to 
the different systems of practice, and we 
shall welcome the continuation of this arti- 
cle. 

Servoss had no intention of burdening 
you twice in one month, but the Editor 
seemed to have a different idea of how 
things should be. I believe, however, that 
you will agree with me in asking for more 
of the practical. 

Goiter is a thing always of interest and 



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THE MEDICAL SUMMARY 



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we thank Gregory for his remarks on the 
subject. He says nothing of the method of 
the Mayos in their radical cure, through 
surgical interference. The medical treat- 
ment is important and should be tried out, 
probably in the vast majority of cases, 
prior to calling upon the surgeon. The 
ideas suggested by Gregory sound good, 
and should be followed up and reported on 
by others. 

Perhaps the moon may have some con- 
nection with the occurrence of labor. Who 
knows? Evans has made some remarks 
relative to the subject which should awaken 
quite a discussion. Don't let the matter 
drop right here, but follow it up, as sug- 
gested by Evans, and let us hear from both 
our city and country brothers. Let us 
hear whether you think old Luna has any- 
thing to do with labor, or not. 

It goes without saying that the Editor 
has picked up some good things for "Medi- 
cal Gleanings." This department invari- 
ably contains something of interest to every 
reader of the Summary, and it should 
never, under any circumstances, be passed 
over lightly. I would say in passing that 
of all the aconite products, I have person- 
ally found aconitine, either the amorphous or 
crystal, to be the most satisfactory form 
of the drug, in that it is invariably reliable 
and of exact standard, lot for lot. 

Under the head of "Notes and Queries," 
Gregory again gives us some good ideas 
which should lead to greater therapeutic 
thought. I would suggest to the doctor 
that he employ, inste